A Pharmacoeconomic Evaluation of the Use of Dexrazoxane in Preventing Anthracycline-Induced Cardiotoxicity in Patients with Stage IIIB or IV Metastatic Breast Cancer
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Abstract
A Markov model was developed to determine the cost of treating patients with stage
IIIB or IV metastatic breast cancer with 5-fluorouracil, doxorubicin, and cyclophosphamide
(FAC) and dexrazoxane (administered after six courses of FAC) versus FAC alone. The
primary end point in our economic study was cost per cardiac event avoided. Cost per
life-year saved was also calculated, even though the survival advantage needs to be
confirmed in follow-up studies. The model incorporated the direct medical costs of
treating patients with chemotherapy, as well as the costs associated with treatment
of any cardiac events that occurred. Data were collected for this analysis from several
sources, including completed clinical trials on FAC plus dexrazoxane versus FAC plus
placebo (obtained from two patient groups randomized at different time points), a
panel of three oncologists, and a panel of three cardiologists. Analyses showed that
therapy with dexrazoxane costs $5661.77 per cardiac event prevented. Sensitivity analyses
on model variables were performed and showed that the basic results of the model did
not change when parameters were varied. The clinical efficacy and cost-effectiveness
of dexrazoxane as shown by the results of the current study encourage further investigation
of the uses of dexrazoxane in other populations and against other comparators.