title: When to recommend and to pay for first-line adjuvant breast cancer treatment? A structured review of the literature.
abstract: A structured review of studies on the health-economic evaluation of systemic adjuvant therapy for early-stage breast cancer was carried out. Of the eight articles that have been identified four were related to the cost-effectiveness of chemotherapy, three compared chemotherapy with combined chemotherapy and hormonal therapy and one compared tamoxifen (TAM) with third-generation aromatase inhibitors (ATIs). Results of the review indicate that the cost-utility of adjuvant breast cancer therapy is within the range of other oncological interventions. Adjuvant chemotherapy is most cost-effective in pre-menopausal women with node-positive breast cancer while cost-effectiveness decreases considerably with increasing age. Endocrine therapy with TAM is most cost-effective in ER-positive tumours with no significant age effect. The cost-utility of using the ATI anastrozole instead of TAM in adjuvant therapy cannot be conclusively assessed on the basis of the existing evidence.
authors.affiliation: University of Ulm, Department of Psychiatry II, BKH Günzburg, Günzburg, Germany.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.forename: Franz
authors.initials: F
authors.lastname: Porzsolt
mesh_terms: D047072:Aromatase Inhibitors / Q000191:economics*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006801:Humans; D020845:Selective Estrogen Receptor Modulators / Q000191:economics*; D013629:Tamoxifen / Q000191:economics*; D014481:United States
chemical_list: D047072:Aromatase Inhibitors; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen