Adjuvant chemotherapy for breast cancer: A cost-utility analysis of FEC-D vs. FEC 100

Tallal Younis, Daniel Rayson, Marlene Sellon, Chris Skedgel

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background: Adjuvant 5-flurouracil, epirubicin and cyclophosphamide- docetaxel (FEC-D) has been shown to improve disease-free and overall survival (DFS and OS), compared to FEC 100, for node-positive breast cancer. An economic evaluation was undertaken to examine the cost-utility (CU) of FEC-D relative to FEC 100 given possible differences in cost between the two regimens. Methods: A Markov model was developed to calculate the cumulative costs and quality-adjusted life years (QALY) gained over a 10-year horizon for a hypothetical cohort of 1,000 women with node-positive breast cancer treated with FEC 100 or FEC-D. Event rates, costs, and utilities were derived from the literature. Efficacy outcomes were based primarily on the hazard ratio of DFS for all patients, but separate analyses were also conducted according to age and menopausal status as per the PACS 01 subgroup analysis results. The model took a third-party direct payer perspective and reports results in 2006 Canadian dollars ($). Both costs and benefits were discounted at 3%. Results: FEC-D is associated with 0.156 QALY gain and a $2,280 incremental cost compared to FEC 100, with a CU of $14,612/QALY gained. Results were robust to model assumptions and input parameters in a sensitivity analysis but were marginal in pre-menopausal and younger women. Conclusions: Adjuvant FEC-D is a cost-effective alternative to FEC 100, with a cost-effectiveness ratio well below commonly employed thresholds. The CU according to age and menopausal status should be considered in view of the potential differences in efficacy in these subgroups, if any.

Original languageEnglish
Pages (from-to)261-267
Number of pages7
JournalBreast Cancer Research and Treatment
Issue number2
Publication statusPublished - Sept 2008
Externally publishedYes


  • Adjuvant chemotherapy
  • Breast cancer
  • Chemotherapy
  • Cost
  • Cost-utility

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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