title: A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer.
abstract: Breast cancer is a global health concern. In fact, breast cancer is the primary cause of death among women worldwide and constitutes the most expensive malignancy to treat. As health care resources are finite, decisions regarding the adoption and coverage of breast cancer treatments are increasingly being based on "value for money," i.e., cost-effectiveness. As the evidence about the cost-effectiveness of breast cancer treatments is abundant, therefore difficult to navigate, systematic reviews of published systematic reviews offer the advantage of bringing together the results of separate systematic reviews in a single report. As a consequence, this paper presents an overview of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer to inform policy and reimbursement decision-making. A systematic review was conducted of published systematic reviews documenting cost-effectiveness analyses of breast cancer treatments from 2000 to 2014. Systematic reviews identified through a literature search of health and economic databases were independently assessed against inclusion and exclusion criteria. Systematic reviews of original evaluations were included only if they targeted breast cancer patients and specific breast cancer treatments (hormone therapy, chemotherapy, and targeted therapy only), documented incremental cost-effectiveness ratios, and were reported in the English language. The search strategy used a combination of these key words: "breast cancer," "systematic review/meta-analysis," and "cost-effectiveness/economics." Data were extracted using predefined extraction forms and qualitatively appraised using the assessment of multiple systematic reviews (AMSTAR) tool. The literature search resulted in 511 bibliographic records, of which ten met our inclusion criteria. Five reviews were conducted in the early-stage breast cancer setting and five reviews in the metastatic setting. In early-stage breast cancer, evidence about trastuzumab value differed by age. Trastuzumab was cost-effective only in women with HER2-positive breast cancer younger than 65 years and over a life-time horizon. The cost-effectiveness of trastuzumab in HER2-positive metastatic breast cancer yielded conflicting results. The same conclusions were reached in comparisons between vinorelbine and taxanes. In both early stage and advanced/metastatic breast cancer, newer aromatase inhibitors (AIs) have proved cost-effective compared to older treatments. This overview of systematic reviews shows that there is heterogeneity in the evidence concerning the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer. The cost-effectiveness of these treatments depends not only on the comparators but the context, i.e., adjuvant or metastatic setting, subtype of patient population, and perspective adopted. Decisions involving the cost-effectiveness of breast cancer treatments could be made easier and more transparent by better harmonizing the reporting of economic evaluations assessing the value of these treatments.
authors.affiliation: Division of Economic, Social and Administrative Pharmacy College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA.
authors.forename: Vakaramoko
authors.initials: V
authors.lastname: Diaby
authors.affiliation: Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Tawk
authors.affiliation: Unité de Formation et de Recherche (UFR) Sciences Economiques et Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.|Center for Economic Forecasting and Analysis (CEFA), Florida State University (FSU), Tallahassee, FL, USA.
authors.forename: Vassiki
authors.initials: V
authors.lastname: Sanogo
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, FL, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Taussig Cancer Center Department of Solid Tumor Oncology, Cleveland, OH, USA.
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Montero
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D004358:Drug Therapy / Q000191:economics; D005260:Female; D006728:Hormones / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D058990:Molecular Targeted Therapy / Q000191:economics; D009367:Neoplasm Staging; D000078202:Systematic Reviews as Topic; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use; D014747:Vinblastine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000077235:Vinorelbine
chemical_list: D006728:Hormones; D043823:Taxoids; D014747:Vinblastine; D000077235:Vinorelbine