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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References
Peters WP, Shpall EJ, Jones RB et al. High-dose combination alkylating agents with bone marrow support as initial treatment for metastatic breast cancer. J Clin Oncol 1988; 6: 1368–1376.
Williams SF, Mick R, Desser R et al. High-dose consolidation therapy with autologous stem cell rescue in stage IV breast cancer. J Clin Oncol 1989; 7: 1824–1830.
Kennedy MJ, Beveridge RA, Rowley SD et al. High-dose chemotherapy with reinfusion of purged autologous bone marrow following dose-intense induction as initial therapy for metastatic breast cancer. J Natl Cancer Inst 1991; 83: 920–926.
Antman K, Ayash L, Elias A et al. A phase II study of high-dose cyclophosphamide, thiotepa, and carboplatin with autologous marrow support in women with measurable advanced breast cancer responding to standard-dose therapy. J Clin Oncol 1992; 10: 102–110.
Williams SF, Gilewski T, Mick R, Bitran JD . High-dose consolidation therapy with autologous stem-cell rescue in stage IV breast cancer: follow-up report. J Clin Oncol 1992; 10: 1743–1747.
Zujewski J, Nelson A, Abrams J . Much ado about not… enough data: high-dose chemotherapy with autologous stem cell rescue for breast cancer. J Natl Cancer Inst 1998; 90: 200–209.
Gaskin DJ, Kong J, Meropol NJ et al. Treatment choices by seriously ill patients: the Health Stock Risk Adjustment model. Med Decis Making 1998; 18: 84–94.
Burstein HJ, Gelber S, Guadagnoli E, Weeks JC . Use of alternative medicine by women with early stage breast cancer. N Engl J Med 1999; 340: 1733–1739.
Stadtmauer EA, O'Neill A, Goldstein LJ et al. Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group. N Engl J Med 2000; 342: 1069–1076.
1998 Drug Topics Red Book. Medical Economics Company, Inc: Montvale, NJ, 1998.
Stephenson J . Researchers struggle with trials of stem-cell transplants for breast cancer. JAMA 1997; 277: 1827–1829.
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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DOI: https://doi.org/10.1038/sj.bmt.1703795
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