Economic evaluation of antiaromatase agents in the second-line treatment of metastatic breast cancer.
OBJECTIVE
An economic evaluation was conducted comparing anastrozole, exemestane, letrozole and megestrol for the second-line treatment of postmenopausal patients with hormone-sensitive metastatic breast cancer who had failed tamoxifen.


METHODS
An economic model was developed based on data from phase III megestrol-controlled clinical trials of antiaromatase agents (AA) and estimates of resource utilization from both Statistic Canada's Population Health Model for breast cancer and expert opinion.


RESULTS
In megestrol-controlled trials, anastrozole and exemestane equivalently improved survival compared to megestrol, while letrozole did not. Compared to megestrol, exemestane and anastrozole both cost Canadian $9000 per life-year gained, and letrozole saved Canadian $300 annually, with no life-year gain. Cost-effectiveness results were robust under sensitivity analysis testing. However, the model was dependent on any difference between AAs with respect to survival benefit and drug acquisition price.


CONCLUSIONS
Based on available data and this cost-effectiveness analysis, exemestane and anastrozole are appropriate choices for second-line hormonal treatment of metastatic breast cancer.
Verma
Shailendra
S
Ottawa Regional Cancer Centre, 503 Smyth Road, K1H 1C4, Ottawa, Canada.
Rocchi
Angela
A
D000368:Aged; D000077384:Anastrozole; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D047072:Aromatase Inhibitors; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D002170:Canada; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D004791:Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077289:Letrozole; D008535:Megestrol / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009570:Nitriles / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use
D000730:Androstadienes; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D004791:Enzyme Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole; D000077289:Letrozole; D008535:Megestrol; C056516:exemestane