Tamoxifen plus chemotherapy versus tamoxifen alone as adjuvant therapies for node-positive postmenopausal women with early breast cancer: a stochastic economic evaluation.
BACKGROUND
There remains uncertainty around the appropriate choice of adjuvant therapies to offer postmenopausal women with node-positive early breast cancer.


OBJECTIVE
To present the results derived from a discrete event simulation (DES) model that compared tamoxifen plus chemotherapy versus tamoxifen alone in node-positive postmenopausal women diagnosed with early breast cancer.


METHODS
The data populating the model were mainly derived from the existing literature, which was analysed to specify probability distributions describing the uncertainty around the true value of each input parameter. The specified probability distributions facilitated the stochastic analysis of the decision model, whereby distributions of the model's outputs [aggregate costs and quality-adjusted life years (QALYs)] were estimated.


RESULTS
The baseline results show that the addition of chemotherapy to tamoxifen in this patient group is relatively cost effective (under pound 4000 per additional QALY), but the distribution of the incremental cost-effectiveness ratio shows a wide range, including 10% of observations in which tamoxifen dominates tamoxifen plus chemotherapy.


CONCLUSIONS
The results demonstrate the intuitive nature of stochastic evaluations of healthcare technologies, which may ease decision-makers' interpretation of cost-effectiveness results.
Karnon
Jonathan
J
Health Economics Research Group, Brunel University, Uxbridge, Middlesex, United Kingdom. jon.karnon@hsl.gov.uk
Brown
Jackie
J
D000368:Aged; D016588:Anticarcinogenic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D015203:Reproducibility of Results; D013629:Tamoxifen / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
D016588:Anticarcinogenic Agents; D000970:Antineoplastic Agents; D013629:Tamoxifen