Cost-Utility Analysis of Best Supportive Care Versus Oncoplatin And Oncotaxel in the Treatment of Recurrent Metastatic Breast Cancer

BACKGROUND: For patients diagnosed with recurrent metastatic breast cancer, the prognosis is grim. Two agents, Oncoplatin and Oncotaxel, have been used to help prolong the lives of these patients (authors would cite clinical literature here for real pharmaceutical products). As with other chemotherapy treatments, the toxic effects of the medications can be severe and vastly decrease the patient's quality of life. Some would argue that the small increase in life expectancy from these agents might not be worth the tradeoff in suffering from the adverse effects of the agents during the treatment period. Instead of chemotherapy, palliative treatments, such as best supportive care (BSC), have been suggested as an option. BSC includes measures to keep the patient comfortable. These may include medications to alleviate pain, antibiotics, or radiotherapy to reduce tumor size. The objective of this study was to compare the costs and utility of two chemotherapy treatments, Oncoplatin and Oncotaxel, with those of BSC in patients with recurrent metastatic breast cancer.

METHODS: The practice sites for data collection included three oncology clinics that are part of a multihospital, multiclinic health care system. Utility scores were collected via the time tradeoff (TTO) method. A panel of experts helped create descriptions of the health states of patients undergoing the different treatment options. Based on these descriptions, utility scores were elicited from a random sample of patients from general (nononcology) clinics associated with the health care system.

Data on treatment and survival time were collected for the past 3 years from a retrospective analysis of charts at three oncology clinics. Medical services and procedures associated with these treatment options were recorded. Treatment data included medications and their administration, as well as laboratory, radiology, and various types of medical visits (physician, clinic, emergency room, and hospital). Because treatment costs were not available, charges listed by the health care system in 2019 were used to estimate current costs for each service or procedure.

RESULTS: Table 1 lists the costs and survival times found by the review of charts. Using the TTO method, treatment utility scores were estimated by a random sample of patients who did not have cancer. Although the chemotherapy regimens provided a longer survival (Oncoplatin, 210 days; Oncotaxel, 170 days) than BSC (140 days), the utility score was higher for BSC (0.60) compared with the chemotherapy regimens (0.32-0.54).

Table 1. Oncology study data

DATA	Treatment A	Treatment B	Treatment C
	BSC (n = 29)	Oncoplatin (n = 36)	Oncotaxel (n = 35)
Treatment costs: Mean (SD)	$6000 ($1000)	$11,000 ($2500)	$7500 ($2000)
Survival: Mean (range)	140 days (110-160 days)	210 days (180-225 days)	170 days (110-205 days)
Utility scores:	0.60	0.32	0.54

Abbreviations: n = number of patients in the sample, SD = standard deviation

The composite article has been truncated here so that you can perform the analysis.

Questions:

1. Incorporating quality of life with survival times, what is the average cost-effectiveness ratio (CER) for each treatment? Express the CER in dollars per QALY, not dollars per QALD (quality-adjusted life days):

a. Treatment A (BSC)

b. Treatment B (Oncoplatin)

c. Treatment C (Oncotaxel)

2. What is the incremental cost-effectiveness ratio (ICER), again using QALYs, comparing:

a. Treatment B (Oncoplatin) with Treatment A (BSC)

b. Treatment C (Oncotaxel) with Treatment A (BSC)

3. Cost-effectiveness grid:

a. Place “B vs. A” in the cell that represents comparing Treatment B (Oncoplatin) with Treatment A (BSC).

b. Place “C vs. A” in the cell that represents comparing Treatment C (Oncotaxel) with Treatment A (BSC).

Cost / Outcome	Lower cost	Same cost	Higher cost
Less effective
Same effectiveness
More effective

4. Threshold Analysis for Treatment B (Oncoplatin):

a. If a threshold (also called "willingness to pay") of $50,000 is used as the value of a QALY, do your calculations indicate that Treatment B (Oncoplatin) is a cost-effective option, compared to Treatment A (BSC)?

b. Does your answer change if a threshold of $100,000 per QALY is used?

c. Are the ICER results sensitive to this threshold range [$50,000 to $100,000/QALY]? Why or why not?

5. Threshold Analysis for Treatment C (Oncotaxel): Repeat 4 a, b, and c above for Treatment C (Oncotaxel).

a. If a threshold (also called "willingness to pay") of $50,000 is used as the value of a QALY, do your calculations indicate that Treatment C (Oncotaxel) is a cost-effective option, compared to Treatment A (BSC)?

b. Does your answer change if a threshold of $100,000 per QALY is used?

c. Are the ICER results sensitive to this threshold range [$50,000 to $100,000/QALY]? Why or why not?