title: Cost-effectiveness of adjuvant systemic therapy in low-risk breast cancer patients with nodal isolated tumor cells or micrometastases.
abstract: BACKGROUND
  The cost-effectiveness of adjuvant systemic therapy in patients with low-risk breast cancer and nodal isolated tumor cells or micrometastases is unknown.
  
  
  METHODS
  A cost-effectiveness analysis of adjuvant systemic therapy was carried out using the costs per 1% event prevented after 5 years of follow-up as incremental cost-effectiveness ratio (ICER). Secondary objective was to establish when adjuvant systemic therapy becomes cost saving. Patients included in the MIRROR study with isolated tumor cells or micrometastases who had a complete 5-year follow-up and who either did or did not receive systemic therapy were eligible. Sensitivity analyses were carried out.
  
  
  RESULTS
  In the no adjuvant therapy cohort (N = 366), 24.9% of patients had an event within 5 years versus 16.8% of patients in the adjuvant therapy cohort (N = 483) (P < 0.01). The ICER was €363 per 1% event prevented. Beyond 18 years after diagnosis, the extrapolated mean cumulative costs per patient in the no adjuvant therapy cohort exceeded those of the adjuvant therapy cohort.
  
  
  CONCLUSIONS
  In this population of breast cancer patients with isolated tumor cells or micrometastases, €36 300 had to be invested to prevent one event in 5 years of follow-up. Adjuvant systemic therapy was cost saving beyond 18 years after diagnosis.
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht; Comprehensive Cancer Centre East, Nijmegen.
authors.forename: M
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: E M M
authors.initials: EMM
authors.lastname: Adang
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: K C G
authors.initials: KCG
authors.lastname: Van Dycke
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: J A A M
authors.initials: JAAM
authors.lastname: van Dijck
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: G F
authors.initials: GF
authors.lastname: Borm
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht.
authors.forename: S C
authors.initials: SC
authors.lastname: Seferina
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht.
authors.forename: C H M
authors.initials: CHM
authors.lastname: van Deurzen
authors.affiliation: Department of Pathology, University Medical Centre Utrecht, Utrecht.
authors.forename: P J
authors.initials: PJ
authors.lastname: van Diest
authors.affiliation: Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Bult
authors.affiliation: Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: A R T
authors.initials: ART
authors.lastname: Donders
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht. Electronic address: vcg.tjan.heijnen@mumc.nl.
authors.forename: V C G
authors.initials: VCG
authors.lastname: Tjan-Heijnen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012307:Risk Factors