The pharmacoeconomics of cancer therapies

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is a taxane with a wide spectrum of antitumor activity. Combination chemotherapy with paclitaxel plus cisplatin has been shown to be more active than older drug combinations in the treatment of ovarian cancer and non-small cell lung cancer. Paclitaxel also appears to be as active as other therapies for the first-line treatment of breast cancer, and an established salvage treatment after platinum therapy for ovarian cancer and after anthracycline therapy for breast cancer. Ongoing clinical trials are evaluating the role of paclitaxel in the adjuvant treatment of breast cancer and in early stage lung cancer. Cost analysis of combination paclitaxel/cisplatin treatment for ovarian cancer indicated drug costs represented a low proportion of inpatient costs, making it cost effective per life-year gained in both the inpatient and outpatient settings. In extensive cost analyses of lung cancer therapies in Canada, best supportive care for stage IV lung cancer was shown to cost more than Can$28,000. In this setting, with an expected increase in survival, the cost of treating stage IV lung cancer with paclitaxel appears to be cost effective. Furthermore, in a large randomized study of paclitaxel versus cyclophosphamide/methotrexate/5-fluorouracil/prednisone in breast cancer, preliminary results suggested that paclitaxel may be associated with equivalent cancer control, quality of life, and less side effects. Thus, future research will consider the cost-benefit of improved quality of life with paclitaxel therapy and evaluate the comparative cost-benefit when taxanes are used to treat earlier-stage disease.