title: Cost-effectiveness analysis review of exemestane in the treatment of primary and advanced breast cancer.
abstract: BACKGROUND
  Exemestane was approved in 2005 for adjuvant treatment of breast cancer. In this study, we aimed to assess whether it is cost-effective in comparison to available alternatives.
  
  
  METHODS
  To evaluate the efficacy of exemestane, a systematic review was conducted by searching electronic databases. The outcomes of interest were "clinical benefit", "overall response" and "disease-free survival rate". To evaluate the cost of treatments, costs of both domestic generic and imported brand medicines were taken into account, and the incremental cost-effectiveness ratio (ICER) was calculated for each comparison.
  
  
  RESULTS
  Regarding primary breast cancer, based upon available evidence, exemestane could not be considered as a cost-effective medicine either in generic or brand form compared with placebo (ICER: 119,100 and 215,525), with tamoxifen after 2-3 years of therapy (ICER: 35,150 and 82,400) and with sequential treatment by tamoxifen and exemestane (dominated because of lower effectiveness and higher cost). In metastatic breast cancer, exemestane was not considered a cost-effective treatment compared with both anastrozole and megestrol acetate (dominated) and was highly cost-effective compared with tamoxifen (ICERs: 2,208 and 4,326 dollars per one more patient with an overall response for generic and brand medicines) although even in this case it was not cost-effective in terms of the 1-year survival rates (dominated).
  
  
  CONCLUSIONS
  Regarding current evidence and related costs in terms of Iranian pharmaceutical market prices, exemestane could not be considered a cost-effective treatment in primary and advanced breast cancer compared with available alternatives. However, more evidence is still needed for more certain decisions.
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran ; Non-Communicable Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Hashemi-Meshkini
authors.forename: Khosro
authors.initials: K
authors.lastname: Keshavarz
authors.forename: Zahra
authors.initials: Z
authors.lastname: Gharibnaseri
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Kheirandish
authors.forename: Abbas
authors.initials: A
authors.lastname: Kebriaeezadeh
authors.forename: Shekoufeh
authors.initials: S
authors.lastname: Nikfar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
keywords: anastrozole; cost-effectiveness; evidence based medicine; exemestane; letrozole; megestrol acetate; systematic review