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Population-Based Pharmacoeconomic Model for Adopting Capecitabine/Docetaxel Combination Treatment for Anthracycline-Pretreated Metastatic Breast Cancer

^a Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada; ^b University of Toronto, Department of Health Policy, Management and Evaluation, Toronto, Ontario, Canada

Correspondence: Shailendra Verma, M.D., FRCPC, Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada. Telephone: 613-737-7700; Fax: 613-247-3511; e-mail: shailendra.verma{at}orcc.on.ca

Purpose. To model the cost-effectiveness of adopting capecitabine/docetaxel combination therapy in place of single-agent taxane therapy for women in the province of Ontario, Canada, receiving treatment for anthracycline-pretreated metastatic breast cancer.

Methods. Clinical effectiveness and economic data were combined in a population model, from the perspective of a universal health care system. Estimates of clinical effectiveness and medical resource utilization were derived prospectively during a phase III randomized controlled trial comparing single-agent docetaxel with capecitabine/docetaxel combination therapy. Population data were obtained from the Cancer Care Ontario Registry and provincial prescription claims data.

Results. During 1999–2000, 542 patients were eligible for taxane monotherapy. As capecitabine/docetaxel treatment confers a median 3-month survival benefit compared with docetaxel monotherapy, the projected survival gain in these patients was 136 life-years. The results of the cost-effectiveness analysis demonstrate that the survival benefit provided by the addition of capecitabine to single-agent docetaxel is afforded at a small incremental cost of Canadian $3,691 per life-year gained. Hospitalization costs for treatment of adverse events were less for patients receiving capecitabine/docetaxel combination therapy than for those receiving docetaxel monotherapy. The results were robust for adjustments in treatment costs and adverse effects costs.

Conclusion. Due to its 3-month survival gain and small incremental treatment cost, capecitabine/docetaxel is judged to be a highly cost-effective treatment in anthracycline-pretreated advanced breast cancer. From the perspective of the Ontario health care system, the addition of capecitabine to docetaxel in this patient population is a clinically appropriate and economically acceptable treatment strategy.

Key Words. Population based • Pharmacoeconomic • Capecitabine • Docetaxel • Metastatic breast cancer

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