Adjuvant fluorouracil, epirubicin and cyclophosphamide in early breast cancer: Is it cost-effective?

Abstract

Adjuvant chemotherapy (ACT) in breast cancer exposes patients to morbidity, but improves survival. The FEC (fluorouracil, epirubicin, cyclophosphamide) regimen has taken over the prior role of CMF (cyclophosphamide, methotrexate, fluorouracil). In this model, efficacy, tolerability and quality of life (QoL) data from the literature were incorporated with Norwegian practice and cost data in a cost-effectiveness approach. The FEC efficacy was calculated 3–7% superior CMF. There was no difference in quality of life. An 80–100% dose intensity range was employed, one Euro (€ 1) was calculated NOK 8.78 and a 3% discount rate was used. The total cost of FEC employing the friction cost method on production loss, including amount spent on drugs, administration and travelling ranged between € 3 278–3 850 (human capital approach € 12 143–12 715). Money spent on drugs alone constituted 15–48%, depending on method chosen. A cost-effectiveness analysis revealed a cost per life year (LY) saved replacing FEC by CMF of € 3 575–15 125. Adjuvant FEC is cost effective in Norway.