Economic analyses of toxicity secondary to anthracycline-based breast cancer chemotherapy

Doxorubicin (D) is one of the most active agents in the treatment of breast cancer but can be associated with cardiotoxicity (CT) and febrile neutropenia (FN). Epirubicin, a stereoisomer of doxorubicin, is reported to have similar efficacy but reduced toxicity. A retrospective chart audit was performed to estimate the incidence, average length of hospitalisation and resource consumption for the management of CT and FN in 200 patients breast cancer patients receiving equidoses of doxorubicin or epirubicin. Overall, there were three more episodes of CT in the doxorubicin group than in epirubicin patients (five versus two) at a cost of Canadian dollars C$4268/episode. With regard to FN, there were 11 more episodes in the doxorubicin arm (25 versus 14) at a cost of C$5419/episode. The results of the study support the substitution of equidose epirubicin for doxorubicin in women undergoing treatment for malignancies of the breast. Such a policy may result in reduced toxicity-related management costs.