333P - Cost effectiveness of adjuvant cyclophosphamide containing regimes to at in the treatment of breast cancer in germany

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Bioethics, Legal, and Economic Issues
Breast Cancer
Presenter Evelyn Walter
Authors E. Walter
  • IPF Institute for Pharmaeconomic Research, 1010 - Vienna/AT



58,000 women in Germany are diagnosed with breast cancer each year. Anthracycline-containing regimes - in addition to other treatment options - have been standard adjuvant breast cancer regimens. The purpose of this analysis was to estimate the cost-effectiveness of AT (doxorubicin, docetaxel) compared with AC (doxorubicin, cyclophosphamide), CMF (cyclophosphamide, methotrexat, 5-fluoruracil) and FEC (5-fluoruracil, epirubicin, cyclophosphamide) administered as adjuvant therapy to women with node-positive breast cancer in Germany.


We developed a multi-country Cost-Utility-Model to simulate the long-term consequences from initiation of adjuvant chemotherapy over 10 years. Markov modelling techniques were used to estimate incidence of complications during chemotherapy (febrile neutropenia, chemotherapy induced nausea/vomiting, dose-reduction, dose-delay, other grade 3/4 adverse events) and long-term consequences like local or distant relapse, secondary acute myelogenous leukemia, chronic heart failure and death. Monte-Carlo-simulation accounted for uncertainty. Probabilities were derived from clinical and epidemiological studies; direct costs from published sources from the payer's perspective. QALYs, life years and costs were discounted at 3% p.a.


Over a 10-year timeframe, costs and outcomes associated with AT amounts to 21,055.91 € and 6.3 QALYs (7 LYs). Costs associated with AC are 17,018.04 €, while outcomes are comparable to AT. The cost saving potential associated to AC vs. AT amounts to 4,037.87 € per patient. Costs and outcomes associated with CMF are 17,790.42 € and 6.3 QALYs (6.94 LYs), leading to a cost saving potential of € 3,265.49 with CMF vs AT. FEC associated total costs are 18,471.84 €. Quality-adjusted life expectancy increases to 6.5 years, which represents a QALY gain of 0.2 QALYs over 10 years vs. AT. The increase in life expectancy without quality adjustment amounts to 7.4 years and leads to 0.4 LYs gained with FEC versus AT. Accordingly, FEC dominates AT.


Cyclophosphamide-based regimens (FEC, AC and CMF) demonstrate a better performance from cost-effectiveness perspective vs. AT (doxorubicin, docetaxel).


All authors have declared no conflicts of interest.