Major electronic databases were searched between October 2005 and February 2006.
REVIEW METHODS: Eight of the 11 selected trials (six
docetaxel and five
paclitaxel) reported a significant improvement in disease-free survival (DFS) or time to recurrence (TTR) for
taxanes over comparator regimens.
Docetaxel was associated with more adverse events than
paclitaxel, most notably
febrile neutropenia.
Taxanes produced
cardiotoxicity, although this was not reported to be greater than for
anthracycline comparator arms in all trials. Treatment-related deaths were uncommon. Where reported, all
chemotherapy regimens caused HRQoL to deteriorate during treatment. Following treatment, there were no clinically significant differences between
taxane and comparator treatment groups. There were few data available comparing licensed regimens of
taxanes with
chemotherapy regimens commonly used in the UK. The three trials selected as the basis for the economic analysis were those that used the
taxanes in accordance with current UK marketing authorisation and had also reported in full. The estimated incremental cost-effectiveness ratio for
docetaxel compared to FAC6, based on the BCIRG 001 study, is 12,000 pounds (7000-39,000 pounds) and for
paclitaxel compared with
Adriamycin/
cyclophosphamide, based on the NSABP B28 and CALGB 9344 studies, is 43,000 pounds (16,000 pounds-dominated) and 39,000 pounds (12,000 pounds-dominated), respectively. However, the comparators used in these trials restrict the generalisability of the results, as they do not conform to current standard care in the UK, typically FEC6 and E4-CMF4. An exploratory indirect comparison shows that the benefits of
taxane containing regimens compared to regimens in current use in the UK is subject to large uncertainty due to the lack of direct trial comparisons between these interventions. Assumptions regarding the benefits in the
taxane arm after the trial follow-up period and the annual rate of recurrence in this period have the most significant influence on the ICER.
CONCLUSIONS: There is a large degree of heterogeneity in the evidence base for the effectiveness of
taxane- compared with non-
taxane-containing regimens in terms of the interventions, comparators and populations. Eight of the 11 trials providing effectiveness data reported a significant improvement in DFS or TTR for
taxanes over comparator regimens. The remaining three trials found no significant differences between the groups in DFS/TTR. The cost-effectiveness results suggest that the cost per quality-adjusted life-year for
taxane- compared with non-
taxane-containing
chemotherapy varies between 12,000 pounds and 43,000 pounds, depending on the
taxane under consideration and the specific trial used as the basis of the analysis. However, the comparators used in these trials do not conform to current standard care in the UK. More research is needed, comparing
taxanes used in line with their current UK marketing authorisation and with
anthracycline-containing regimens commonly used in the UK. The on-going TACT trial is expected to provide useful data. There are currently few data on the effectiveness of
taxanes for the over-70s. Further research is required into the long-term outcomes of
taxane therapy, such as whether there are any long-term adverse events that significantly impact on overall survival or quality of life and whether the increases in DFS will translate into increases in overall survival.