title: Cost-Effectiveness of Chemotherapy for Breast Cancer and Age Effect in Older Women.
abstract: BACKGROUND
  Previous economic evaluations compared specific chemotherapy agents using input parameters from clinical trials and resource utilization costs. Cost-effectiveness of treatment groups (drug classes) using community-level effectiveness and cost data, however, has not been assessed for elderly patients with breast cancer.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of chemotherapy regimens by age and disease stage under "real-world" conditions for patients with breast cancer.
  
  
  METHODS
  The Surveillance Epidemiology and End Results-Medicare data were used to identify patients with breast cancer with American Joint Committee on Cancer stage I/II/IIIa, hormone receptor-negative (estrogen receptor-negative and progesterone receptor-negative) patients from 1992 to 2009. Patients were categorized into three adjuvant treatment groups: 1) no chemotherapy, 2) anthracycline, and 3) non-anthracycline-based chemotherapy. Median life-years and quality-adjusted life-years (QALYs) were measured using Kaplan-Meier analysis and were evaluated against average total health care costs (2013 US dollars).
  
  
  RESULTS
  A total of 4575 patients (propensity score-matched) were included for the primary analysis. The anthracycline group experienced 12.05 QALYs and mean total health care costs of $119,055, resulting in an incremental cost-effectiveness ratio of $7,688 per QALY gained as compared with the no chemotherapy group (QALYs 7.81; average health care cost $86,383). The non-anthracycline-based group was dominated by the anthracycline group with lower QALYs (9.56) and higher health care costs ($122,791). Base-case results were found to be consistent with the best-case and worst-case scenarios for utility assignments. Incremental cost-effectiveness ratios varied by age group (range $3,790-$90,405 per QALY gained).
  
  
  CONCLUSIONS
  Anthracycline-based chemotherapy was found cost-effective for elderly patients with early stage (stage I, II, IIIa) breast cancer considering the US threshold of $100,000 per QALY. Further research may be needed to characterize differential effects across age groups.
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA. Electronic address: David.R.Lairson@uth.tmc.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Parikh
authors.affiliation: Division of Surgical Oncology and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.affiliation: Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA; Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000191:economics* / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D019057:Quality-Adjusted Life Years; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents
keywords: breast cancer; chemotherapy; cost-effectiveness; cost-utility