title: Cost-utility analysis of adjuvant goserelin (Zoladex) and adjuvant chemotherapy in premenopausal women with breast cancer.
abstract: BACKGROUND
  Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer.
  
  
  METHODS
  In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0), and to obtain the utility value by the standard gamble (SG) and visual scale (VS) methods. Total medical cost was assessed from the (National Health Insurance) NHI payer's perspective.
  
  
  RESULTS
  Survival at 11 years was significantly better in the groserelin group (P < 0.0012). The lifetime lost was lower in the goserelin group (42 months vs. 66 months). The quality adjusted survival (QAS) of patients who received goserelin was longer (122.5 ± 6.3 vs. 112.2 ± 6.7 months). Total expenses of goserelin were more than cyclophosphamide, methotrexate, 5-fluorouracil (CMF) or 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy regimes, but less than docetaxel, epirubicin (TE) or docetaxel, epirubicin, cyclophosphamide (TEC) regimes. The quality-adjusted life-year was higher in the goserelin group.
  
  
  CONCLUSIONS
  Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.
authors.affiliation: Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. m002010@ms.skh.org.tw
authors.forename: Tsui Fen
authors.initials: TF
authors.lastname: Cheng
authors.forename: Jung Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Wu Ching
authors.initials: WC
authors.lastname: Uen
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D017024:Chemotherapy, Adjuvant / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017273:Goserelin / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D017697:Premenopause; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin