Cost-Effectiveness Analysis of Two Chemotherapy Regiments FAC vs. Taxane for Operable Breast Cancer Patients in Indonesia

Saptaningsih, Agusdini Banun; Nikmah, Umi Sa’adatun; Aryandono, Teguh; Dwiprahasto, Iwan; At Thobari, Jarir

doi:10.31557/APJCP.2022.23.4.1147

Cost-Effectiveness Analysis of Two Chemotherapy Regiments FAC vs. Taxane for Operable Breast Cancer Patients in Indonesia

Document Type : Research Articles

Authors

¹ 1Directorate of Pharmaceutical Production and Distribution, Directorate General of Pharmaceuticals and Medical Devices, Ministry of Health of the Republic of Indonesia, Indonesia.

² Clinical Epidemiology and Biostatistics Unit (CE&BU), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia.

³ Department of Surgery, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia.

⁴ Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia.

10.31557/APJCP.2022.23.4.1147

Abstract

Background: Breast cancer is the deadliest cancer among women worldwide including Indonesia. Both FAC and Taxane-based chemotherapies are often used for patients with early node-positive breast cancer. However, the study regarding the cost-effectiveness of those regiments is still rare. This study aims to analyze the cost-effectiveness of Taxane versus FAC in the Indonesia setting. Methods: Twenty-four patients with stage I-IIIA breast cancer who had received surgery, FAC or Taxane-based adjuvant chemotherapy, and radiation were included in this study. Health-related quality of life was assessed using INA-BCHRQoL. INA-BCHRQoL was mapped to the EuroQoL 5D (EQ-5D) index calculator to get the utility score. All direct cost was retrieved from electronic medical records and hospital information system. Whereas, a questionnaire was designed to collect information about society cost from patients. ICER was counted to summarize the cost-effectiveness of two chemotherapy regiments (Taxane versus FAC). A sensitivity analysis was done to assess the uncertainty result. Results: The results showed there was no significant difference between the score of quality of life and utility in respondents who received FAC chemotherapy and Taxane-based chemotherapy. However, in terms of cost, Taxane was 6.5 times higher than the FAC group per patient for chemotherapy drugs only. Moreover, the total cost of treatments in Taxane-based chemotherapy was approximately 3.7 times more costly than the counterpart in the FAC arm (p=0.000). Taxane-based chemotherapy dominated with ICER IDR 765.213.092 per QALY gained. Overall, FAC was found more cost-effective compared to the Taxane regiment. Conclusion: FAC represents the value of money compared to Taxane-based for breast cancer patients with stage I-IIIA in Indonesia.

Keywords