title: Cost-effectiveness analysis of anastrozole versus tamoxifen in adjuvant therapy for early-stage breast cancer - a health-economic analysis based on the 100-month analysis of the ATAC trial and the German health system.
abstract: BACKGROUND
  In the 'Arimidex', Tamoxifen Alone or in Combination (ATAC) trial, the aromatase inhibitor (AI) anastrozole had a significantly better efficacy and safety profile than tamoxifen as initial adjuvant therapy for hormone receptor-positive (HR+) early breast cancer (EBC) in postmenopausal patients. To compare the combined long-term clinical and economic benefits, we carried out a cost-effectiveness analysis (CEA) of anastrozole versus tamoxifen based on the data of the 100month analysis of the ATAC trial from the perspective of the German public health insurance.
  
  
  METHODS
  A Markov model with a 25-year time horizon was developed using the 100-month analysis of the ATAC trial as well as data obtained from published literature and expert opinion.
  
  
  RESULTS
  Adjuvant treatment of EBC with anastrozole achieved an additional 0.32 quality-adjusted life-years (QALYs) gained per patient compared with tamoxifen, at an additional cost of D 6819 per patient. Thus, the incremental cost effectiveness of anastrozole versus tamoxifen at 25 years was D 21,069 ($30,717) per QALY gained.
  
  
  CONCLUSIONS
  This is the first CEA of an AI that is based on extended follow-up data, taking into account the carryover effect of anastrozole, which maintains the efficacy benefits beyond therapy completion after 5 years. Adjuvant treatment with anastrozole for postmenopausal women with HR+ EBC is a cost-effective alternative to tamoxifen.
authors.affiliation: University Breast Center Franconia, University of Erlangen, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.forename: Agnes
authors.initials: A
authors.lastname: Benedict
authors.forename: Stefan
authors.initials: S
authors.lastname: Buchholz
authors.forename: Noémi
authors.initials: N
authors.lastname: Kreif
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
authors.forename: Rolf
authors.initials: R
authors.lastname: Kreienberg
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaufmann
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Walter
authors.initials: W
authors.lastname: Jonat
authors.forename: Peyman
authors.initials: P
authors.lastname: Hadji
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Distler
authors.forename: Guenther
authors.initials: G
authors.lastname: Raab
authors.forename: Hans
authors.initials: H
authors.lastname: Tesch
authors.forename: Georg
authors.initials: G
authors.lastname: Weyers
authors.forename: Kurt
authors.initials: K
authors.lastname: Possinger
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
mesh_terms: D000077384:Anastrozole; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018803:Models, Economic; D009570:Nitriles / Q000191:economics* / Q000627:therapeutic use*; D013629:Tamoxifen / Q000191:economics* / Q000627:therapeutic use*; D014230:Triazoles / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D009570:Nitriles; D014230:Triazoles; D013629:Tamoxifen; D000077384:Anastrozole