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Cost effectiveness of Epirubicin & Paclitaxel with or without Capecitabine as first-line chemotherapy in metastatic breast cancer: A Markov Modelling Approach
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
2019 (English)Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: In Sweden over 7,800 women were diagnosed in 2017 with breast cancer and 1,400 women died with metastatic breast cancer as the underlying cause of death according to Socialstyrelsen 2018. Although metastatic breast cancer is incurable but it can be effectively managed with treatment strategies that prolong the overall survival, provides good symptoms control and quality of life. Chemotherapy plays a major role in treating breast cancer patients in early and advanced stages. It helps in controlling increment in symptoms and increases the quality of life of a patient. Among common chemotherapy drugs is epirubicin, paclitaxel and capecitabine.

Objective: The main objective of this thesis was to evaluate the incremental cost-effectiveness of TEX treatment (epirubicin and paclitaxel with capecitabine) for metastatic breast cancer in previously treated patients and compared against ET treatment (epirubicin and paclitaxel) using a Markov modeling approach.

Method: An Excel based deterministic State transition (Markov) cohort model was used. The outcome of this model is the incremental cost‐effectiveness ratio (ICER) between the standard ET group (epirubicin & paclitaxel) and the intervention TEX group (epirubicin & paclitaxel plus capecitabine) measured as costs per QALY gained. The main source of data in this Markov model is an open labeled randomized phase III trial (Hatschek et al., 2012). The trial used two outcome measures: progression-free survival and overall survival for each patient. Patients were in the trial until their disease progressed or atmost for 3.5 years followed by a 12 months follow-up period. The costs and adjusted utilities are taken from Sweden, Italy and the UK studies. QALY calculations were discounted at an annual rate of 3% and a Swedish societal perspective has been mainly the focus of this study and both direct medical costs, indirect costs, the costs of TEX and ET interventions have been considered.

Result: For a 5-year time horizon, TEX treatment for patients with metastatic breast cancer yields 1.65 QALYs compared to 1.37 with ET treatment. The cost of ET is SEK 607 750.16 per QALY whereas the cost of TEX is SEK 668 482.74 per QALY. The result of the ICER for TEX is SEK 216 060.77 per QALY.

Conclusion: Based on the results of this model, administering combination treatment of epirubicin, paclitaxel with capecitabine in TEX treatment regimen for treating metastatic breast cancer patients is a cost-effective option compared with epirubicin and paclitaxel in the ET treatment regimen in Sweden.

Place, publisher, year, edition, pages
2019. , p. 26
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2019:11
Keywords [en]
Breast cancer, metastatic breast cancer, chemotherapy, epirubicin, paclitaxel, capecitabine, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-165727OAI: oai:DiVA.org:umu-165727DiVA, id: diva2:1374868
External cooperation
Parexel - Jonas Lindblom, Emma Medin and Vladica Velickovic
Educational program
Master's Programme in Public Health
Presentation
2019-05-22, Room A311, Caring Sciences building, Umeå University, Umeå, 09:00 (English)
Supervisors
Examiners
Available from: 2019-12-05 Created: 2019-12-03 Last updated: 2019-12-10Bibliographically approved

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CiteExportLink to record
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