Cost-utility analysis of adjuvant goserelin (Zoladex) and adjuvant chemotherapy in premenopausal women with breast cancer

被引:14
作者
Cheng, Tsui Fen [1 ]
Wang, Jung Der [2 ]
Uen, Wu Ching [3 ]
机构
[1] Shin Kong Wu Ho Mem Hosp, Dept Surg, Taipei, Taiwan
[2] Natl Cheng Kung Univ, Coll Med & Hosp, Dept Publ Hlth, Tainan 70101, Taiwan
[3] Shin Kong Wu Ho Mem Hosp, Dept Med Oncol, Taipei, Taiwan
关键词
Adjuvant chemotherapy; Adjuvant hormone therapy; Goserelin; Estrogen-responsive (ER plus ); EORTC-QLQ-C30; QALY; Breast cancer; QUALITY-OF-LIFE; METHOTREXATE PLUS FLUOROURACIL; ADJUSTED SURVIVAL; CYCLOPHOSPHAMIDE; THERAPY; PATIENT; EXTRAPOLATION; PREFERENCES; TRIAL; YOUNG;
D O I
10.1186/1471-2407-12-33
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods: In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0), and to obtain the utility value by the standard gamble (SG) and visual scale (VS) methods. Total medical cost was assessed from the (National Health Insurance) NHI payer's perspective. Results: Survival at 11 years was significantly better in the groserelin group (P < 0.0012). The lifetime lost was lower in the goserelin group (42 months vs. 66 months). The quality adjusted survival (QAS) of patients who received goserelin was longer (122.5 +/- 6.3 vs. 112.2 +/- 6.7 months). Total expenses of goserelin were more than cyclophosphamide, methotrexate, 5-fluorouracil (CMF) or 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy regimes, but less than docetaxel, epirubicin (TE) or docetaxel, epirubicin, cyclophosphamide (TEC) regimes. The quality-adjusted life-year was higher in the goserelin group. Conclusions: Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.
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页数:9
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