Review Article
Ramirez-Torres Nicolas MC,
Abstract
Introduction: There are different combinations of neoadjuvant chemotherapy (NCT) to treat locally advanced breast cancer (LABC); treatment with cytostatics drugs make it a costly concern, by establishing economic differences in the consumption of health care resources. Objective: To compare the cost-effectiveness of two NCT strategies. Patients and method: it was made a cost-effectiveness analysis (CEA) of two treatment schemes (4FE100C vs.6FE100C) in patients with clinical stage III breast cancer, each cohort included 48 patients. Effectiveness parameter: pathologic complete response (pCR). Differential cost: incremental cost-effectiveness ratio (ICER) using a Markov’s model. Results are expressed in terms of incremental cost per extra unit of effectiveness. Costs were expressed in Mexican (MXN) pesos ($) as of 2005; these were calculated under the perspective of public health care system (SSP, for its acronym in Spanish) denominated IMSS, with a 3 to 4 years analytical horizon. In order to determine the robustness of the results, a sensitivity analysis was carried out by modifying only the medical direct costs with a 3% discount rate. Results: The use of 6FE100C offered greater effectiveness compared against 4FE100C; the medical direct cost of only the cytostatic drugs for NCT with 6 FE100C and 4 E100C generated a cost per case of $30,467.00 MXN (€ 2,343.61) and $18,004.00 MXN (€ 1,384.92), respectively. The greatest unit price was given by epirubicin. The CEA demonstrated that the cost-effectiveness (C/E) was greater with 6 FE100C and the incremental cost-effectiveness ratio (ICER) showed that it was necessary to pay $11,765,925.42 MXN (€ 905,071.20) because it tells us how much it is paid additionally for every extra unit of effectiveness (pCR) which assumes 6 FE100C in front of 4 FE100C. The sensitivity analysis performed shows the robustness of the results. Conclusion: The 6 FE100C scheme is the strategy with better cost-effectiveness ratio and is the most efficient in the short run for treating LABC.