A trial-based cost-effectiveness analysis of letrozole followed by tamoxifen versus tamoxifen followed by letrozole for postmenopausal advanced breast cancer.
BACKGROUND
Third-generation aromatase inhibitors are being considered as an alternative to tamoxifen as first-line therapy for advanced breast cancer. These newer therapies are more expensive, and will gain greater acceptance if they can demonstrate cost-effectiveness.


METHODS
Life table analyses are used to compare the costs and benefits [life years gained and quality-adjusted life years (QALYs) gained] of treating postmenopausal women with advanced breast cancer with first-line letrozole (with the option of second-line tamoxifen) compared with first-line tamoxifen (with the option of second-line letrozole). Patient-level data from a large clinical trial describes the effectiveness of the therapy options, clinicians estimate resource usage and utility values are obtained from the literature.


RESULTS
The mean cost of providing first- and second-line hormonal therapy is pound 4765 if letrozole is the first-line therapy and pound 3418 if tamoxifen is provided first (a difference of pound 1347). However, patients receiving letrozole as first-line therapy gain an additional 0.228 life years, or 0.158 QALYs. The cost-effectiveness analysis found that first-line hormonal therapy with letrozole gains additional life years at a cost of pound 5917, whilst the cost per additional QALY gained is pound 8514.


CONCLUSIONS
The strategy of letrozole as first-line hormonal therapy not only provides an opportunity for extending and improving patient's quality of life, but also is highly cost-effective compared with other generally accepted medical treatments.
School of Health and Related Research, University of Sheffield, Sheffield, UK. j.karnon@sheffield.ac.uk
J
J
Karnon
S R D
SR
Johnston
T
T
Jones
A
A
Glendenning
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D000077289:Letrozole; D015993:Life Tables; D009570:Nitriles / Q000191:economics* / Q000627:therapeutic use; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D013629:Tamoxifen / Q000191:economics* / Q000627:therapeutic use; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use; D014481:United States
D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077289:Letrozole