Nab-paclitaxel, docetaxel, or solvent-based paclitaxel in metastatic breast cancer: a cost-utility analysis from a Chinese health care perspective

Figures & data

Table 1 Randomized trials selected for the meta-analysis

Trial	Study arms	N	Median age (range)	Overall response	Med TTP (mo)	Med OS (mo)a
Gradishar et al^Citation11	NP 260 mg/m^2 vs	229	53 (26–79)	33% vs	5.4 vs	15.2 vs
	P 175 mg/m^2	225	53 (30–83)	19%	3.9	13.0
Bishop et al^Citation9	P 200 mg/m^2 vs	107	54 (36–73)	29% vs	5.3 vs	17.3 vs
	CMFP	102	54 (32–80)	35%	6.4	13.9
Chan et al^Citation10	D 100 mg/m^2 vs	161	52 (32–74)	48% vs	6.1 vs	15 vs
	Dox 75 mg/m^2	165	52 (25–74)	33%	4.9	14
Paridaens et al^Citation22	P 200 mg/m^2	166	54 (31–74)	25% vs	3.9 vs	15.6 vs
	vs Dox 75 mg/m^2	165	55 (26–75)	41%	7.5	18.3b
Sledge et al^Citation24	P 175 mg/m^2 vs	229	56 (27–76)	34.0% vs	6.3 vs	22.5 vs
	Dox 60 mg/m^2 vs	224	58 (25–79)	36% vs	6.0 vs	19.1b vs
	P 175 + Dox 50 mg/m^2	230	56 (27–78)	47%	8.2	22.4
Jones et al^Citation25	D 100 mg/m^2 vs	225	56 (22–93)	32.0% vs	5.7 vs	15.4 vs
	P 175 mg/m^2	224	54 (28–82)	25.0%	3.6	12.7
Winer et al^Citation23	P 175 mg/m^2 vs	158	NR	21.5% vs	4.0 vs	11.3 vs
	P 210 mg/m^2 vs	156	NR	25.0% vs	4.1 vs	11.9 vs
	P 250 mg/m^2	155	NR	20.0%	4.9	13.8
Bonneterre et al^Citation26	D 100 mg/m^2 vs	86	55 (28–79)	43% vs	6.5 vs	16.0 vs
	V-5FU	90	55 (32–74)	38.8%	5.1	15.0a
Di Leo et al^Citation27	P 175 mg/m^2 vs	288	52 (25–78)	25.3% vs	5.2 vs	19.9 vs
	P 175 mg/m^2 + L	291	51 (23–87)	35.1%	6.6	22.7
Albain et al^Citation28	P 175 mg/m^2 vs	263	53 (27–75)	26.2% vs	4.0 vs	15.8 vs
	P 175 mg/m^2 + G	266	53 (26–83)	41.4%	6.1	18.6

Notes:

a Overall survival for patients being treated in either the first- or second-line setting;

b crossover into the alternative treatment arm was part of the trial protocol.

Abbreviations: 5FU, 5-fluorouracil; CMFP, cyclophosphamide/methotrexate/fluorouracil/prednisone; D, docetaxel; Dox, doxorubicin; G, gemcitabine; L, lapatinib; Med, median; NP, nab-paclitaxel; NR, not reported; OS, overall survival; P, paclitaxel; TTP, time to progression; V, vinorelbine; mo, months; vs, versus.

Table 2 Pooled grade 3/4 toxicity rates with taxane therapy in metastatic breast cancera

Grade 3/4 event	Paclitaxel (%)	Docetaxel (%)	Nab-paclitaxel (%)
Neutropenia	42.6	86.9	30.0
Febrile neutropenia	1.8	10.0	1.8
Anemia	5.1	5.5	1.0
Thrombocytopenia	1.8	2.1	<1.0
Emesis	1.9	6.6	<1.0
Stomatitis	1.0	6.7	<1.0
Diarrhea	1.1	7.2	0.0
Neurotoxicity	7.3	7.0	10.0
Edema	0.0	5.2	0.0
Rash	0.0	1.5	0.0
Hypersensitivity reaction	2.0	2.5	0.0
Treatment-related death	0.7	1.4	0.0

Note:

a These are the point estimates for each side effect that were estimated from the statistical pooling of trial reported grade 3/4 toxicities.

Table 3 Cost of treating selected grade 3/4 toxicities in cancer patients

Grade 3/4 event	Medical intervention	Cost per event ($)^a,b
Neutropenia	Dose reduction or treatment delay	0.00
Febrile neutropenia	Hospital admission with IV antibiotics	621
Anemia	Red cell transfusions in 43% of patients, colony stimulating factors in 33%	913
Thrombocytopenia	Platelet transfusions	155
Emesis	Rescue with 5HT3 antiemetics and steroids	81
Stomatitis	Supportive care of symptoms, hydration if required	5.0
Diarrhea	Oral antidiarrheals, octreotide, and hydration if required	602
Neurotoxicity	Supportive care of symptoms	7.0
Edema	3 days of dexamethasone + prochlorperazine as needed	11.0

Notes:

a The costs to treat each event were determined from expert opinion and from treatment algorithms of the Cancer Hospital of Fu Dan University;

b all costs were converted into 2014 US dollars and were obtained from the Cancer Hospital of Fu Dan University and from the Beijing Municipal Commission of Development and Reform.¹⁸

Abbreviation: IV, intravenous.

Table 4 Nab-paclitaxel, paclitaxel, and docetaxel in metastatic breast cancer: a cost-consequence comparison

Components (95% CI)	Paclitaxel	Docetaxel	Nab-paclitaxel
Clinical data
Dosage	175–200 mg/m^2 q3wks	100 mg/m^2 q3wks	260 mg/m^2 q3wks
Duration of infusion	3 hours	1 hour	20 minutes
Median number of cycles	5	6	6
Overall response	25.3% (22.4%–28.2%)	40.6% (30.1%–51.2%)	33.2% (27.1%–39.3%)
Median progression-free survival	3.9 months	6.1 months	5.4 months
Median overall survival	13 months	15.4 months	15.2 months
Economic data
Drug cost per cycle	$1,520	$2,104	$3,230a
Preparation, administration, and premedication cost per cyclea	$254.14	$158.52	$58.57
Total cost per cycle	$1,774	$2,263	$3,289
Total cost per courseb	$8,871	$13,575	$19,731
Overall cost impact of side effectsc	$69.29	$165.93	$21.04
Overall cost per coursed	$8,940	$13,741	$19,752

Notes:

a Obtained from a time and motion study of 28 breast cancer patients treated in the People’s Republic of China;

b the cost per cycle was multiplied by the median number of cycles administered;

c the % incidence of each side effect in Table 2 was multiplied by the cost per event in Table 3;

d the cost impact of side effects was added to the total cost per course.

Abbreviations: CI, confidence interval; q, every; wks, weeks.

Table 5 Cost-effectiveness and -utility analysis of taxane therapies in metastatic breast cancer

Economic outcomes	Nab-paclitaxel (95% CI)	Docetaxel (95% CI)
Cost-effectiveness analysis^a,b
Cost per PFY gained (vs paclitaxel)	$86,500	$26,200
Cost per LY gained (vs paclitaxel)	$58,900	$24,000
Cost-utility analysis^a,b
Quality-adjusted life-years gained	0.19 (0.13 to 0.25)	0.037 (–0.012 to 0.086)
Cost per QALY gained^c,d	$57,900 ($38,200 to $128,800)	$130,600 ($35,700 to dominated)e

Notes:

a Rounded to the nearest hundred;

b relative to paclitaxel;

c incremental cost of nab-paclitaxel and docetaxel was divided by the gain in QALYs;

d 95% CI limits were estimated using the 95% CI limits for the difference in the healthy month equivalent (ie, in the denominator), while keeping the cost differences relative to paclitaxel (ie, in the numerator) constant;

e dominated means that docetaxel is more costly and does not provide more benefit in terms of QALYs gained than paclitaxel.

Abbreviations: CI, confidence interval; LY, life-year; PFY, progression-free year; QALY, quality-adjusted life-year.

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