title: Cost-utility of adjuvant hormone therapies with aromatase inhibitors in post-menopausal women with breast cancer: upfront anastrozole, sequential tamoxifen-exemestane and extended tamoxifen-letrozole.
abstract: This evaluation adapts a previous Canadian analysis of upfront and sequential adjuvant AI strategies in postmenopausal women with breast cancer to a Belgian perspective and includes an extended aromatase inhibitor (AI) strategy. A Markov model calculated monthly costs and outcomes in a hypothetical cohort of postmenopausal women with early-stage breast cancer. Baseline event rates and hazard ratios were derived from the Arimidex, Tamoxifen Alone or in Combination trial, International Exemestane Study and MA.17 trials. The analysis took a Belgian healthcare payer perspective with a 20-year time horizon. Costs and outcomes were discounted by 3%. Costs are in 2005 Euros. The cost-utility of all three strategies was favourable (<30,000 euros per QALY gained). Based on indirect comparisons using tamoxifen (TAM) alone as a common comparator, sequential TAM-AI was less costly and more effective than upfront or extended strategies. All three AI strategies were cost-effective alternatives to TAM alone, but sequential TAM-AI appears to be the economically preferred strategy.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. chris.skedgel@cdha.nshealth.ca <chris.skedgel@cdha.nshealth.ca>
authors.forename: C
authors.initials: C
authors.lastname: Skedgel
authors.forename: D
authors.initials: D
authors.lastname: Rayson
authors.forename: R
authors.initials: R
authors.lastname: Dewar
authors.forename: T
authors.initials: T
authors.lastname: Younis
mesh_terms: D000368:Aged; D000077384:Anastrozole; D000730:Androstadienes / Q000008:administration & dosage / Q000191:economics; D018931:Antineoplastic Agents, Hormonal / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000191:economics*; D001530:Belgium; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics; D002170:Canada; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D000077289:Letrozole; D008390:Markov Chains; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage / Q000191:economics; D017698:Postmenopause; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D013629:Tamoxifen / Q000008:administration & dosage / Q000191:economics; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics
chemical_list: D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane