Cost-effectiveness analysis of docetaxel (Taxotere) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer.

INTRODUCTION: The randomised controlled trial BCIRG001 has recently demonstrated that docetaxel in combination with doxorubicin and cyclophosphamide (TAC) has better efficacy than the standard treatment (FAC, i.e., 5-fluorouracil, doxorubicin and cyclophosphamide) in the adjuvant treatment of patients with node-positive breast cancer. The cost-effectiveness of TAC vs. FAC in the Spanish setting is analysed. PATIENTS AND METHODS: Clinical outcomes from trial BCIRG001 were combined with Spanish costs and longterm efficacy of FAC and TAC extrapolated up to 5 years by means of a Markov model. Results are shown as cost per life year gained (C/LYG) and cost per quality-adjusted life year (C/QALY). Costs and effects were discounted at a rate of 3%. RESULTS: Mean survival was 17.8 and 16.5 years for TAC and FAC, with total costs of euro14,611 and euro11,586, respectively. The results of the cost-effectiveness analysis showed that TAC achieves a C/LYG and a C/QALY of only euro2345 and euro2631, respectively. Sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: Combined therapy based on docetaxel (TAC) is not only an effective option, but also presents a favourable cost-effectiveness ratio, clearly below the Spanish efficiency threshold in all the scenarios considered.

Cost-effectiveness analysis of docetaxel (Taxotere) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer

INTRODUCTION: The randomised controlled trial BCIRG001 has recently demonstrated that docetaxel in combination with doxorubicin and cyclophosphamide (TAC) has better efficacy than the standard treatment (FAC, i.e., 5-fluorouracil, doxorubicin and cyclophosphamide) in the adjuvant treatment of patients with node-positive breast cancer. The cost-effectiveness of TAC vs. FAC in the Spanish setting is analysed. PATIENTS AND METHODS: Clinical outcomes from trial BCIRG001 were combined with Spanish costs and longterm efficacy of FAC and TAC extrapolated up to 5 years by means of a Markov model. Results are shown as cost per life year gained (C/LYG) and cost per quality-adjusted life year (C/QALY). Costs and effects were discounted at a rate of 3%. RESULTS: Mean survival was 17.8 and 16.5 years for TAC and FAC, with total costs of euro14,611 and euro11,586, respectively. The results of the cost-effectiveness analysis showed that TAC achieves a C/LYG and a C/QALY of only euro2345 and euro2631, respectively. Sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: Combined therapy based on docetaxel (TAC) is not only an effective option, but also presents a favourable cost-effectiveness ratio, clearly below the Spanish efficiency threshold in all the scenarios considered (AU)

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Análisis coste-efectividad de vareniclina (Champix®) en el tratamiento del tabaquismo en España / Cost effectiveness analysis of varenicline (Champix®) for the treatment of smoking in Spain

Objetivos: Analizar la eficiencia de la vareniclina (Champix®) versus bupropion y TSN (terapia sustitutiva con nicotina) y tratamiento no farmacológico en España. Métodos: Se utilizó un modelo de Markov para analizar las consecuencias clínicas y económicas del tabaquismo y distintas intervenciones para dejar de fumar. Las probabilidades fueron tomadas de la literatura y ensayos clínicos, siendo utilizadas para estimar la efectividad de las opciones comparadas (vareniclina, bupropión, TSN y no tratamiento farmacológico), para distintos horizontes temporales. Los resultados se expresaron en años de vida (AV) ganado y coste por años de vida ajustados por calidad (AVAC) ganado de vareniclina vs comparadores. El análisis se realizó desde la perspectiva del Sistema Nacional de Salud, descontando los costes al 3,5% anual. Resultados: La mayor eficacia de vareniclina supone una reducción de la morbi-mortalidad asociada al tabaquismo, que a largo plazo, compensa totalmente el coste adicional del tratamiento respecto a los comparadores.Vareniclina se muestra como una opción dominante respecto a todas las alternativas en el análisis a largo plazo (toda la vida de los sujetos). Incluso tomando horizontes temporales más cortos (20 años) resulta coste efectivo, siempre menos de 9.000 €/AVAC ganado en comparación con cualquier alternativa. Conclusiones: Vareniclina es una opción dominante (más efectiva amenor coste) comparada con los demás tratamientos, cuando se considera toda la vida del sujeto. Vareniclina es una terapia coste-efectiva incluso cuando se consideran horizontes temporales más cortos (a partir de 20 años), con un coste efectividad incremental muy por debajo del umbral aceptado en nuestro entorno

Objective: To analyse the efficiency of varenicline compared with bupropion, NRT (nicotine replacement therapy) and no pharmacological treatment in Spain. Methods: A Markov model was developed to analyse the health and economic consequences of smoking cessation therapies. The transition probabilities were taken from published studies. The model allows cost effectiveness analyses for different time frames (10 years, 20 years and life time). Outcomes are measured in terms of incremental life years gained (LYG) and QALYs. Pharmacological costs and costs of medical visits with varenicline and bupropion were considered. Treatment costs of smoking associated morbidity were taken from Spanish studies. Results: The analyses were done under the perspective of the National Health System, discounting costs and health benefits at 3%. Results:The life time cost-effectiveness analysis shows that varenicline dominates all other smoking cessation interventions (more effective at a lower cost).This is due to the higher efficacy of varenicline associated with a reductionin smoking related morbimortality, which, in the long term, accounts for health care cost savings that overcome the extra cost of varenicline. Even when shorter time frames are considered (20 years), vareniclin is cost-effective in comparison with any other alternative. Conclusions: Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), withan estimated incremental cost per QALY far bellow any thresh old commonly accepted in our environment

[Cost effectiveness analysis of varenicline (Champix) for the treatment of smoking in Spain]. / Análisis coste-efectividad de vareniclina (Champix) en el tratamiento del tabaquismo en España.

OBJECTIVE: To analyse the efficiency of varenicline compared with bupropion, NRT (nicotine replacement therapy) and no pharmacological treatment in Spain. METHODS: A Markov model was developed to analyse the health and economic consequences of smoking cessation therapies. The transition probabilities were taken from published studies. The model allows cost effectiveness analyses for different time frames (10 years, 20 years and life time). Outcomes are measured in terms of incremental life years gained (LYG) and QALYs. Pharmacological costs and costs of medical visits with varenicline and bupropion were considered. Treatment costs of smoking associated morbidity were taken from Spanish studies. RESULTS: The analyses were done under the perspective of the National Health System, discounting costs and health benefits at 3%. The life time cost-effectiveness analysis shows that varenicline dominates all other smoking cessation interventions (more effective at a lower cost). This is due to the higher efficacy of varenicline associated with a reduction in smoking related morbimortality, which, in the long term, accounts for health care cost savings that overcome the extra cost of varenicline. Even when shorter timeframes are considered (20 years), vareniclin is cost-effective in comparison with any other alternative. CONCLUSIONS: Varenicline is a dominant option (more effective at a lower cost) compared with all other smoking cessation treatments when the timeframe is the life span of the patient. Varenicline is cost-effective even when shorter timeframes are considered (20 years or more), with an estimated incremental cost per QALY far bellow any threshold commonly accepted in our environment.

[Cost-effectiveness analysis of enoxaparin for the prophylaxis of venous thromboembolism in major orthopedic surgery patients]. / Análisis coste-efectividad de enoxaparina en la proxilaxis de la enfermedad tromboembólica venosa en pacientes sometidos a cirugía mayor ortopédica.

OBJECTIVES AND METHODS: A retrospective, modeled, cost-effectiveness analysis was conducted with enoxaparin versus non-prophylaxis, tinzaparin, and unfractionated heparin for venous thromboembolic disease in Spanish patients undergoing major orthopedic surgery from the standpoint of the Spanish national health system. Episodes avoided and life-years gained with each treatment were estimated by a meta-analysis of clinical trials. RESULTS: With enoxaparin fewer thromboembolic episodes and deaths occurred, when compared to the available alternative options. Enoxaparin was the dominant option (lower total cost and equal or greater effectiveness than any alternative option) in comparison with non-prophylaxis, tinzaparin, and unfractionated heparin. A sensitivity analysis confirmed the stability of these results. CONCLUSION: The administration of enoxaparin as a prophylactic treatment for venous thromboembolic disease in patients undergoing hip or knee surgery is a cost-effective intervention in every case, and less expensive than the alternative options used in Spain.

Análisis coste-efectividad de enoxaparina en la profilaxis de laenfermedad tromboembólica venosa en pacientes sometidos acirugía mayor ortopédica / Cost-effectiveness analysis of enoxaparin for the prophylaxis of venous thromboembolism in major orthopedic surgery patients

Objetivos y métodos: Se hizo un análisis coste-efectividad, retrospectivo y modelizado, de enoxaparina frente a la no profilaxis, tinzaparina y heparina no fraccionada de la enfermedad tromboembólica venosa, en pacientes españoles sometidos a cirugía mayor ortopédica, desde la perspectiva del Sistema Nacional de Salud. Los episodios evitados y años de vida ganados con cada tratamiento se estimaron mediante un metaanálisis de ensayos clínicos. Resultados: Con enoxaparina hubo un menor número de episodios tromboembólicos y muertes que con las opciones alternativas. Enoxaparina fue la opción dominante (costes totales menores y efectividad igual o mayor que la opción alternativa) en comparación con la no profilaxis, tinzaparina y las heparinas no fraccionadas. El análisis de sensibilidad confirmó la estabilidad de estos resultados. Conclusión: La administración de enoxaparina como profilaxis de la enfermedad tromboembólica venosa, en la cirugía de cadera o rodilla, es una intervención coste-efectiva en todos los casos, suponiendo un ahorro respecto a opciones alternativas utilizadas en nuestro país. (AU)