A stochastic economic evaluation of letrozole versus tamoxifen as a first-line hormonal therapy: for advanced breast cancer in postmenopausal patients.
BACKGROUND
Letrozole is a third-generation aromatase inhibitor that is a feasible alternative to tamoxifen as a first-line hormonal therapy for patients with advanced breast cancer.


OBJECTIVE
This paper presents the results of an economic evaluation comparing letrozole and tamoxifen as first-line hormonal therapies in postmenopausal women diagnosed with advanced breast cancer.


CONCLUSIONS
UK National Health Service.


METHODS
A decision model (Markov process) was built describing possible patient pathways from the point of diagnosis to death. The model was populated using patient-specific clinical trial data, data from the existing literature, and expert opinion. Stochastic analyses of the model were undertaken, whereby the majority of the input parameters were described as probability distributions to represent the uncertainty about their true value. Costs were presented in year 2000 values.


RESULTS
The baseline results showed that letrozole is a cost-effective alternative to tamoxifen with a mean incremental cost per life-year gained of pound 2342, whilst the incremental cost increases to just over pound 10,000 at the 95th percentile of the cost-effectiveness range (2000 values).


CONCLUSIONS
The results of the economic analysis indicate that letrozole is a cost-effective alternative first-line therapy compared with tamoxifen for postmenopausal women with advanced breast cancer, achieving additional life-years with a modest increase in costs.
Karnon
Jon
J
School of Health and Related Research, University of Sheffield, Sheffield, England.
Jones
Trefor
T
D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D047072:Aromatase Inhibitors; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D000077289:Letrozole; D008390:Markov Chains; D008954:Models, Biological; D009570:Nitriles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic; D013269:Stochastic Processes; D013629:Tamoxifen / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077289:Letrozole