Impact médico-économique du docétaxel dans le traitement adjuvant du cancer du sein

Docetaxel in combination with the conventional anticancer agents doxorubicin and cyclophosphamide (TAC) has shown better efficacy than 5-fluorouracil (5FU) combined with the same agents (FAC) as adjuvant treatment for women with early breast cancer in a randomised controlled trial (BCIRG001). The objective of this economic analysis was to estimate the cost-effectiveness of TAC versus FAC in patients with early breast cancer in France. Based on the BCIRG001 trial, a lifetime Markov model comparing TAC and FAC was developed. Direct medical costs were taken into account The perspective was that of the French public health insurance. All the costs and health outcomes were extrapolated over a lifetime horizon in order to obtain a cost per life-year gained. Patients receiving TAC had a longer life expectancy than those treated with FAC (28.61 versus 26.33 years). Overall lifetime average costs were €20,837 and €16,143, respectively, for TAC and FAC. The incremental cost-effectiveness ratio (ICER) was €2,059 in the base case, varying from €1,474 to €4,963 according to the multi-ways sensitivity analysis. This economic analysis shows that TAC is highly cost-effective in the management of early breast cancer in France. TAC remains cost-effective even adding primary G-CSF prophylaxis in the prevention of neutropenia.