Cost-effectiveness analysis of docetaxel (Taxotere®) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer

Introduction The randomised controlled trial BCIRG001 has recently demonstrated that docetaxel in combination with doxorubicin and cyclophosphamide (TAC) has better efficacy than the standard treatment (FAC, i.e., 5-fluorouracil, doxorubicin and cyclophosphamide) in the adjuvant treatment of patients with node-positive breast cancer. The cost-effectiveness of TAC vs. FAC in the Spanish setting is analysed. Patients and methods Clinical outcomes from trial BCIRG001 were combined with Spanish costs and long-term efficacy of FAC and TAC extrapolated up to 5 years by means of a Markov model. Results are shown as cost per life year gained (C/LYG) and cost per quality-adjusted life year (C/QALY). Costs and effects were discounted at a rate of 3%. Results Mean survival was 17.8 and 16.5 years for TAC and FAC, with total costs of €14,611 and €11,586, respectively. The results of the cost-effectiveness analysis showed that TAC achieves a C/LYG and a C/QALY of only €2345 and €2631, respectively. Sensitivity analysis confirmed the robustness of the results. Conclusions Combined therapy based on docetaxel (TAC) is not only an effective option, but also presents a favourable cost-effectiveness ratio, clearly below the Spanish efficiency threshold in all the scenarios considered.