[A cost-effectiveness study of first-line hormone therapy in post-menopausal patients with metastatic breast cancer on neoadjuvant treatment].
OBJECTIVE
Breast cancer is a hormone-dependent tumor, which expands therapy options. The aim of this study was to perform a pharmacoeconomic assessment of these drugs in post-menopausal patients with metastatic breast cancer or on neoadjuvant therapy.


METHODS
To assess the efficacy of both drug classes a meta-analysis was carried out from papers obtained in a Medline literature search (1997 - June 2004) using the following keywords: breast cancer, postmenopausal, aromatase inhibitors, antiestrogens, tamoxifen, neoadjuvant. Effectiveness parameters included: objective response, percentage with conservative surgery in neoadjuvancy; in metastatic breast cancer, time to progression. Costs were considered from drug acquisition data. To determine result strength a sensitivity analysis was undertaken, with modified costs and effectiveness.


RESULTS
Results show a higher effectiveness for aromatase inhibitors as compared to antiestrogens. In neoadjuvant therapy: 56.38% versus 36% for objective response rate, and 47.64% versus 35% for conservative surgery. In metastatic cancer: 9.96 versus 6.61 months for time to progression (p <or= 0.05). The pharmacoeconomic analysis showed that selecting anastrozole represents a cost of 969 euros and 779 euros per extra effectiveness unit regarding objective response and conservative surgery, respectively, whereas in metastatic cancer patients it represents 56,525 euros per extra effectiveness unit.


CONCLUSIONS
Selecting an aromatase inhibitor is a valid option in neoadjuvancy, even if such selection would represent a very high cost for metastatic cancer.
Ballester Viéitez
A
A
Servicio de Farmacia, Hospital Clínico Universitario, Valencia, Spain. ana.ballester.vieitez@sergas.es
Ferriols Lisart
F
F
Magraner Gil
J
J
D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D017698:Postmenopause
D047072:Aromatase Inhibitors; D020847:Estrogen Receptor Modulators