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Value Health Reg Issues. 2019 Sep;19:65-74. doi: 10.1016/j.vhri.2019.03.001. Epub 2019 May 13.

Cost-Effectiveness of Docetaxel and Paclitaxel for Adjuvant Treatment of Early Breast Cancer: Adaptation of a Model-Based Economic Evaluation From the United Kingdom to South Africa.

Author information

1
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK. Electronic address: a.o.alshreef@sheffield.ac.uk.
2
SAMRC/Wits Centre for Health Economics and Priority Setting, PRICELESS SA, School of Public Health, Faculty of Health Sciencess, University of the Witwatersrand, Johannesburg, South Africa.
3
Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
4
Essential Drugs Programme, National Department of Health, Pretoria, South Africa.
5
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
6
York Health Economics Consortium, University of York, York, England, UK.
7
Department of Economics and Related Studies, University of York, York, England, UK.
8
MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, England, UK.
9
MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, England, UK; Centre for Global Development Europe, London, England, UK.

Abstract

OBJECTIVES:

Transferability of economic evaluations to low- and middle-income countries through adaptation of models is important; however, several methodological and practical challenges remain. Given its significant costs and the quality-of-life burden to patients, adjuvant treatment of early breast cancer was identified as a priority intervention by the South African National Department of Health. This study assessed the cost-effectiveness of docetaxel and paclitaxel-containing chemotherapy regimens (taxanes) compared with standard (non-taxane) treatments.

METHODS:

A cost-utility analysis was undertaken based on a UK 6-health-state Markov model adapted for South Africa using the Mullins checklist. The analysis assumed a 35-year time horizon. The model was populated with clinical effectiveness data (hazard ratios, recurrence rates, and adverse events) using direct comparisons from clinical trials. Resource use patterns and unit costs for estimating cost parameters (drugs, diagnostics, consumables, personnel) were obtained from South Africa. Uncertainty was assessed using probabilistic and deterministic sensitivity analyses.

RESULTS:

The incremental cost per patient for the docetaxel regimen compared with standard treatment was R6774. The incremental quality-adjusted life years (QALYs) were 0.24, generating an incremental cost-effectiveness ratio of R28430 per QALY. The cost of the paclitaxel regimen compared with standard treatment was estimated as -R578 and -R1512, producing an additional 0.03 and 0.025 QALYs, based on 2 trials. Paclitaxel, therefore, appears to be a dominant intervention. The base case results were robust to all sensitivity analyses.

CONCLUSIONS:

Based on the adapted model, docetaxel and paclitaxel are predicted to be cost-effective as adjuvant treatment for early breast cancer in South Africa.

KEYWORDS:

early breast cancer; low- and middle-income countries; model adaptation; transferability

PMID:
31096179
DOI:
10.1016/j.vhri.2019.03.001
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