646 Background: MA17 study wasa randomized double-blind placebo-controlled trial of 5 years of extended adjuvant therapy with letrozole (Femara) in 5187 postmenopausal women with early breast cancer after adjuvant tamoxifen. MA17 study demonstrated significant improvement in disease-free survival (93% vs. 87% at 4 yrs, HR 0.57) and a similar trend in overall survival (96% vs. 94% at 4 yrs, HR 0.76). Objective: To estimate the budget impact of adding extended adjuvant letrozole in the management of postmenopausal women with early breast cancer after 5 years adjuvant tamoxifen. Methods: A budget impact analysis over 4 years of letrozole vs. no extended adjuvant therapy was developed from the perspective of a health care payer in terms of total treatment costs following the introduction of letrozole. Model inputs included the overall survival, disease-free survival and probabilities of recurrence from the MA17 trial, additional cost of letrozole and the average annual cost to treat a given type of recurrence (contralateral, loncoregional, metastatic). Only direct medical costs were included using the consumer price index. Costs and cost-savings were reported as 2005 US dollars and discounted at 3%. The average annual cost to treat a recurrence was calculated through a retrospective analysis of a healthcare plan database with 147 postmenopausal women and data from published literature. The recurrence cost included chemotherapy in the first year (drug costs, dispensing fee, materials), health professional contacts, laboratory tests, diagnostic procedures, radiotherapy, bisphosphonate (metastatic recurrence), health professional contacts and hospitalization. Surgery costs were not considered in the study. Results: The average annual cost to treat a recurrence was estimated in US$83,064. For the base-case analysis of 100 patients, savings due to reduced recurrence were $1,006,446, in the letrozole patients. Subtracting the cost of letrozole treatment for 100 patients from savings yielded projected net savings of $36,314. Conclusions: In post-menopausal women who have completed 5 years adjuvant tamoxifen therapy, extended adjuvant letrozole is a cost-saving use of healthcare resources in additional to its clinical benefits. [Table: see text]
Risk of early recurrence among postmenopausal women with estrogen receptor-positive early breast cancer treated with adjuvant tamoxifen
