The cost-effectiveness of adjuvant chemotherapy for early breast cancer: A comparison of no chemotherapy and first, second, and third generation regimens for patients with differing prognoses 5 H.E. Campbell a, * , D. Epstein b , D. Bloomfield c , S. Griffin b , A. Manca b , J. Yarnold d , J. Bliss e , L. Johnson e , H. Earl f , C. Poole g , L. Hiller h , J. Dunn h , P. Hopwood e , P. Barrett-Lee i , P. Ellis j , D. Cameron k , A.L. Harris l , A.M. Gray a , M.J. Sculpher b a Health Economics Research Centre, University of Oxford, Headington, Oxford, OX3 7LF, United Kingdom b Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom c Sussex Cancer Centre, Brighton & Sussex University Hospitals, Brighton, BN2 5BE, United Kingdom d Royal Marsden NHS Trust, London and Sutton, United Kingdom e ICR-CTSU, Section of Clinical Trials, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, United Kingdom f University of Cambridge, Department of Oncology, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, United Kingdom g University of Warwick, Warwick, Coventry, CV4 7AL, United Kingdom h Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom i Velindre Cancer Centre, Velindre Hospital, Cardiff, CF14 2TL, United Kingdom j Guys and St Thomas NHS Foundation Trust, Cancer Management Office, Guys Hospital, London, SE1 9RT, United Kingdom k Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, EH4 2XR, United Kingdom l Cancer Research UK Medical Oncology Department, Churchill Hospital, Headington, Oxford, OX3 7LJ, United Kingdom ARTICLE INFO Article history: Available online 7 July 2011 Keywords: Cost-effectiveness Decision analytic modelling Early breast cancer Chemotherapy ABSTRACT Background: The risk of recurrence following surgery in women with early breast cancer varies, depending upon prognostic factors. Adjuvant chemotherapy reduces this risk; how- ever, increasingly effective regimens are associated with higher costs and toxicity profiles, making it likely that different regimens may be cost-effective for women with differing prognoses. To investigate this we performed a cost-effectiveness analysis of four treatment strategies: (1) no chemotherapy, (2) chemotherapy using cyclophosphamide, methotrexate, and fluorouracil (CMF) (a first generation regimen), (3) chemotherapy using Epirubicin-CMF (E-CMF) or fluorouracil, epirubicin, and cyclophosphamide (FEC60) (a second generation regimens), and (4) chemotherapy with FEC60 followed by docetaxel (FEC-D) (a third gener- ation regimen). These adjuvant chemotherapy regimens were used in three large UK-led randomised controlled trials (RCTs). Methods: A Markov model was used to simulate the natural progression of early breast can- cer and the impact of chemotherapy on modifying this process. The probability of a first recurrent event within the model was estimated for women with different prognostic risk profiles using a parametric regression-based survival model incorporating established 0959-8049/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2011.06.019 5 On behalf of the Centre for Health Economics, York, the ABC, NEATand TACT Trial groups and the Health Economics Research Centre, University of Oxford. * Corresponding author: Address: Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom. Tel.: +44 1865 289274; fax: +44 01865 289271. E-mail address: helen.campbell@dph.ox.ac.uk (H.E. Campbell). EUROPEAN JOURNAL OF CANCER 47 (2011) 2517 – 2530 available at www.sciencedirect.com journal homepage: www.ejconline.com