Cost-effectiveness Analysis Of Adjuvant Therapy For Breast Cancer: Doxorubicin Plus Cyclophosphamide (AC) Versus Docetaxel Plus Cyclophosphamide (TC)

OBJECTIVES1. The cost-effectiveness analysis of doxorubicin / cyclophosphamide (AC) and docetaxel / cyclophosphamide (TC) using Markov model was performed for the purpose of choosing a cost-effective therapy for breast cancer.2. Provide a basis for decision-making for clinical workers and the government, improve the rational use of limited health care resources and make formulation of health policies more scientific and reliable.METHODS1. A Markov model was built to simulate the process of breast cancer events and death in both arms.2. Analyze the Markov model using Roll back, Cohort analysis and Micro-simulation analysis.3. One-way sensitivity analysis and probabilistic sensitivity analysis was performed.4. To test the validity of the model, difference in the rate of disease free between AC and TC as projected by our model were compared to differences reported by the ACTC trial. The transitional probabilities and utilities were derived from foreign clinical studies and published papers. Costs were estimated by reviewing records of patients suffering chemotherapy-related adverse events, with local recurrence, distant recurrence and these who died from breast cancer in a large-scale hospital.RESULTSThe results of Roll back and Cohort analysis showed that patientsreceiving TC gained 14.45 QALYs which were 0.41 QALYs more than patients receiving AC. The lifetime costs of patients receiving TC were 93511yuan which were 10116 yuan more compared with that of AC. The ICER 24305 yuan/QALY, that is, pay 24305 yuan for one more QALY. The results were robust to key parameters in both one-way sensitivity analysis and probabilistic sensitivity analysis.CONCLUSION1. In conclusion, from a Chinese health system perspective, the newrecommended adjuvant chemotherapy regimen, TC was more effective and more costly compared with an AC regimen. TC may be viewed as cost-effective using the general thresholds defined by WHO as the estimated ICUR was less than 3 times per capital GDP in China.2. The application of Markov model could make pharmacoeconomics studies international, get the chance of recognition by foreign peers and improve the development of pharmacoeconomics in China. And finally, make patients medication safe, effective and economic, meanwhile reduce financial burden on patients and government.