title: Cost utility analysis of early adjuvant letrozole or anastrozole versus tamoxifen in postmenopausal women with early invasive breast cancer: the UK perspective.
abstract: Five years with the aromatase inhibitors letrozole or anastrozole is clinically superior to 5 years tamoxifen in postmenopausal women with early breast cancer. This paper analyses the cost-effectiveness of the aromatase inhibitors compared to tamoxifen using the same health economic model. A Markov model describes lifetime incidence of breast cancer events and treatment-related adverse events. Probabilities of disease progression, adverse events, and utility values were estimated using secondary sources; costs of breast-cancer care were obtained from a primary costing study. The incremental cost per QALY gained of letrozole vs. tamoxifen is 10,379pounds (95% CI 6,705-23,574pounds), and of anastrozole versus tamoxifen is 11,428pounds (95% CI 6,211-48,795pounds). If a 5-year carry over effect for the reduction in breast cancer events is assumed, the incremental costs per QALY gained compared to tamoxifen are 6,253pounds (95% CI 3,675-14,766pounds) for letrozole and 7,015pounds (95% CI 3,316-31,997pounds) for anastrozole. Five years of letrozole or anastrozole therapy is cost-effective in postmenopausal women with early breast cancer. Though the respective confidence intervals show significant overlap, letrozole has a 95% probability of being more cost-effective than tamoxifen at a 20,000pounds QALY value, whilst anastrozole has an 85% probability.
authors.affiliation: School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, S1 4DA, UK. j.karnon@sheffield.ac.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
authors.forename: Thomas
authors.initials: T
authors.lastname: Delea
authors.forename: Vicki
authors.initials: V
authors.lastname: Barghout
mesh_terms: D000077384:Anastrozole; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D000077289:Letrozole; D008390:Markov Chains; D009364:Neoplasm Recurrence, Local; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000191:economics; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D017698:Postmenopause; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole; D000077289:Letrozole