Cost–Utility Analysis of Nanoparticle Albumin-Bound Paclitaxel versus Paclitaxel in Monotherapy in Pretreated Metastatic Breast Cancer in Spain

Emilio Alba; Eva Ciruelos; Rafael López; José Manuel López-Vega; Ana Lluch; Miguel Martín; Montserrat Muñoz; Pedro Sánchez-Rovira; Miguel Ángel Seguí; COSTABRAX Working Group; Marta Rubio Liria; Ferran Pérez-Alcántara


Expert Rev Pharmacoeconomics Outcomes Res. 2013;13(3):381-391. 

In This Article

Abstract and Introduction


Aim: The COSTABRAX study evaluated the cost–effectiveness of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) versus polyethylated castor oil-based standard paclitaxel (sb-paclitaxel) in the treatment of patients with previously treated metastatic breast cancer in Spain.

Materials & methods: Efficacy data were obtained from the CA012 trial (nab-paclitaxel administered every 3 weeks [q3w] and sb-paclitaxel q3w) and indirect comparison (sb-paclitaxel administered weekly), and were modeled to a time horizon of 5 years using a Markov model. The analysis was performed from the National Health Service perspective. Use of resources and key assumptions of the model were validated by a panel of 22 local oncologists.

Results: Compared with sb-paclitaxel q3w, nab-paclitaxel q3w was cost effective, with a cost per life year gained of €11,088 and a cost per quality-adjusted life year of €17,808. Compared with sb-paclitaxel administered weekly, it showed savings of €711 per patient.

Conclusion: The COSTABRAX study showed that nab-paclitaxel q3w is a cost-effective alternative compared with sb-paclitaxel q3w and a cost-saving alternative to sb-paclitaxel administered weekly in Spain.


Breast cancer is the most common malignant neoplasia in women in Spain (25,358 women were diagnosed with breast cancer in 2011[101]), and the first cause of cancer-related mortality. Metastatic breast cancer (MBC) is estimated to occur in 20–30% of women with breast cancer.[1]

Currently, MBC is, in most of cases, an incurable disease and treatment goals are primarily palliative and aimed at lengthening the time to disease progression, prolonging survival, reducing symptoms and improving the quality of life.[2,3]

Adjuvant chemotherapy has been shown to reduce the risk of recurrence and prolong overall and disease-free survival.[4] The most frequently used groups of drugs in the adjuvant setting are anthracyclines and taxanes.

nab-paclitaxel (Abraxane®, Celgene, NJ, USA) is a nanoparticle albumin-bound paclitaxel (nab-paclitaxel) without solvent for injectable suspensions that permits the infusion of a dose of paclitaxel significantly higher than those used with paclitaxel formulated with solvents, and allows shorter infusion schedules without premedication. The favorable efficacy and toxicity profile helps to focus treatment on the tumor.[5,6]

nab-paclitaxel is indicated for the second-line treatment of MBC as monotherapy in women in whom other first-line antitumor treatments have failed and standard anthracycline therapy is not indicated.

The approved indication is based on the pivotal, randomized, controlled, Phase III CA012 trial[7] in which nab-paclitaxel administered every 3 weeks (q3w) was compared with polyethylated castor oil-based standard paclitaxel (sb-paclitaxel) q3w. Based on the clinical and economic evidence, nab-paclitaxel was recommended by the health technology agencies of Scotland and Wales[102,103] for the approved indication.

The primary purpose of economic evaluation in healthcare is to provide valid and relevant information to healthcare policymakers and decision-makers regarding the relative value of alternative healthcare interventions, which is of special interest since the healthcare system faces a situation of limited resources.

The COSTABRAX study analyzed the cost–effectiveness of the treatment regimen of nab-paclitaxel q3w versus sb-paclitaxel q3w in patients with MBC in Spain. The analysis was based on the summary of product characteristics approved by the EMA. In addition, since the panel of experts participating in the study indicated that the recommended administration schedule of sb-paclitaxel in Spain is weekly (qw), a second pharmacoeconomic analysis was also conducted comparing nab-paclitaxel q3w with sb-paclitaxel qw.