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Economic Analysis

Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer

Summary:

We performed an economic analysis of data from 180 women in a clinical trial of conventional-dose chemotherapy vs high-dose chemotherapy plus stem-cell transplantation for metastatic breast cancer responding to first-line chemotherapy. Data on resource use, including hospitalizations, medical procedures, medications, and diagnostic tests, were abstracted from subjects' clinical trial records. Resources were valued using the Medicare Fee Schedule for inpatient costs at one academic medical center and average wholesale prices for medications. Monthly costs were calculated and stratified by treatment group and clinical phase. Mean follow-up was 690 days in the transplantation group and 758 days in the conventional-dose chemotherapy group. Subjects in the transplantation group were hospitalized for more days (28.6 vs 17.8, P=0.0041) and incurred higher costs ($84 055 vs $28 169) than subjects receiving conventional-dose chemotherapy, with a mean difference of $55 886 (95% CI, $47 298–$63 666). Sensitivity analyses resulted in cost differences between the treatment groups from $36 528 to $75 531. High-dose chemotherapy plus stem-cell transplantation resulted in substantial additional morbidity and costs at no improvement in survival. Neither the survival results nor the economic findings support the use of this procedure outside of the clinical trial setting.

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Acknowledgements

This study was supported by an unrestricted educational grant from US Healthcare, Blue Bell, PA, and by Public Health Service Grants (CA15488, CA23318, CA16520, CA42777, CA32102, CA27525, CA13650, CA07190, CA66636, and CA21115) from the National Cancer Institute, the National Institutes of Health, and the Department of Health and Human Services. The views expressed in this manuscript do not necessarily represent the views of the US government. Presented in part at the 36th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, 20–23 May 2000. Drs Pines and Jackman are now with the University of Virginia Health System, Charlottesville. We thank Bradley Hammill, MA, for his statistical and programming assistance and Damon Seils, MA, for editorial assistance and manuscript preparation.

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Schulman, K., Stadtmauer, E., Reed, S. et al. Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Bone Marrow Transplant 31, 205–210 (2003). https://doi.org/10.1038/sj.bmt.1703795

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