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Open Access Highly Accessed Research article

Cost-utility analysis of adjuvant goserelin (Zoladex) and adjuvant chemotherapy in premenopausal women with breast cancer

Tsui Fen Cheng1*, Jung Der Wang2 and Wu Ching Uen3

Author affiliations

1 Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road Shih Lin, Taipei, Taiwan

2 Department of Public Health National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan

3 Department of Medical Oncology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road Shih Lin Taipei, Taiwan

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Citation and License

BMC Cancer 2012, 12:33  doi:10.1186/1471-2407-12-33

Published: 21 January 2012

Abstract

Background

Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer.

Methods

In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0), and to obtain the utility value by the standard gamble (SG) and visual scale (VS) methods. Total medical cost was assessed from the (National Health Insurance) NHI payer's perspective.

Results

Survival at 11 years was significantly better in the groserelin group (P < 0.0012). The lifetime lost was lower in the goserelin group (42 months vs. 66 months). The quality adjusted survival (QAS) of patients who received goserelin was longer (122.5 ± 6.3 vs. 112.2 ± 6.7 months). Total expenses of goserelin were more than cyclophosphamide, methotrexate, 5-fluorouracil (CMF) or 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy regimes, but less than docetaxel, epirubicin (TE) or docetaxel, epirubicin, cyclophosphamide (TEC) regimes. The quality-adjusted life-year was higher in the goserelin group.

Conclusions

Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.

Keywords:
Adjuvant chemotherapy; Adjuvant hormone therapy; Goserelin; Estrogen-responsive (ER+); EORTC-QLQ-C30; QALY; Breast cancer