title: Cost-effectiveness of anastrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer.
abstract: BACKGROUND
  In a recent trial of first-line therapy in 353 postmenopausal women with predominantly hormone receptor-positive advanced breast cancer (the North American trial), anastrozole 1 mg QD produced a significantly longer time to disease progression (TTP) than tamoxifen 20 mg QD (11.1 months vs 5.6 months; P = 0.005). Both treatments were well tolerated, but there were fewer thromboembolic events and a reduced incidence of vaginal bleeding with anastrozole.
  
  
  OBJECTIVE
  The aim of this study was to conduct an economic analysis of anastrozole versus tamoxifen based on data from the North American trial.
  
  
  METHODS
  Quality-adjusted TTP (QATTP) was determined by combining TTP values with uniform or graded weights for adverse events using the Quality-adjusted Time Without Symptoms and Toxicity method. Direct health care costs before and after disease progression were determined from the perspective of 4 types of health care insurers in the United States: health maintenance organizations (HMOs), indemnity plans, preferred provider organizations (PPOs), and point-of-service (POS) plans.
  
  
  RESULTS
  Median QATTP with graded weights was 9.7 months for anastrozole, compared with 4.6 months for tamoxifen (P = 0.003). A resultant reduction in health care resource utilization was observed, particularly the requirements for hospitalization, outpatient visits, and chemotherapy, but the statistical significance of this observation was not assessed. Incremental cost savings per patient before and after disease progression were observed with anastrozole compared with tamoxifen (9064 dollars for HMO, 9678 dollars for indemnity plan, 14,273 dollars for PPO, and 12,715 dollars for POS; all P < 0.01).
  
  
  CONCLUSIONS
  In the US managed care setting, anastrozole produced a higher QATTP and incurred lower treatment costs than tamoxifen in a population of postmenopausal women with predominantly hormone receptor-positive advanced breast cancer. Therefore, anastrozole was more cost-effective than tamoxifen as first-line endocrine therapy in the population studied.
authors.affiliation: Global Health Economics & Outcomes Research Inc., Summit, New Jersey 07901, USA. rsimons@globalhealtheconomics.com
authors.forename: W Robert
authors.initials: WR
authors.lastname: Simons
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.forename: Aman
authors.initials: A
authors.lastname: Buzdar
mesh_terms: D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D009570:Nitriles / Q000191:economics* / Q000627:therapeutic use; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D013629:Tamoxifen / Q000191:economics* / Q000627:therapeutic use; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole