Economic analysis of albumin-bound paclitaxel for the treatment of metastatic breast cancer.

BACKGROUND An albumin-bound formulation of paclitaxel (nab-paclitaxel) was developed to provide additional efficacy and to overcome the safety drawbacks of paclitaxel and docetaxel in patients with metastatic breast cancer. To provide health economic data for the Canadian setting, an economic analysis comparing each of nab-paclitaxel and docetaxel, both as alternatives to paclitaxel in metastatic breast cancer was conducted. METHODS The clinical and safety data were obtained from a meta-analysis of randomized trials comparing either nab-paclitaxel (260 mg/m(2) q3wk) or docetaxel (100 mg/m( 2) q3wk), to standard paclitaxel (175 mg/m(2) q3wk). Health care resource use for the delivery of chemotherapy and the management of grade III/IV toxicity was collected from the oncology literature. Treatment preferences and health state utilities were obtained from 24 female oncology nurses and pharmacists using the time trade-off technique. RESULTS Nab-paclitaxel had the lowest incidence of grade III/IV toxicity. This translated to lower overall costs for managing the grade III/IV events relative to both docetaxel and paclitaxel ($597 vs. $2626 vs. $1227). Using the median number of cycles administered and the cost impact of grade III/ IV toxicity, the overall cost for nab-paclitaxel would be $15,105 compared to $15,268 for docetaxel and $3557 for paclitaxel. When treatment preferences were assessed, 20 of 24 (83.3%) respondents selected nab-paclitaxel as their preferred choice compared to only 4 who selected docetaxel. These corresponded to a gain of 0.203 and 0.016 QALYs for nab-paclitaxel and docetaxel, respectively. With these utility benefits, the incremental cost per QALY gained was more favorable for nab-paclitaxel than docetaxel ($56,800 vs. $739,600). CONCLUSIONS Nab-paclitaxel would be an economically reasonable alternative to docetaxel in MBC patients. As an alternative to paclitaxel, formulary committees must decide if the $56,800 cost per QALY represents good value in their health care setting.