2062 POSTER Comparison of the cost-effectiveness of upfront letrozole or anastrozole, or switched exemestane versus tamoxifen for early breast cancer in hormone receptor positive (HR+) postmenopausal women: the UK perspective

2007 ◽  
Vol 5 (4) ◽  
pp. 202-203
Author(s):  
F. Di Trapani ◽  
J. Karnon ◽  
S. Kaura
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Hormone Receptor Positive ◽  
The Uk ◽  
The Cost

Cost-effectiveness of letrozole and anastrozole as adjuvant therapy for hormone receptor positive early breast cancer in postmenopausal women

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10577-10577
Author(s):  
T. E. Delea ◽  
J. Karnon ◽  
V. Barghout ◽  
S. K. Thomas ◽  
N. L. Papo
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Adjuvant Therapy ◽  
Postmenopausal Women ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
Hormone Receptor Positive ◽  
The Cost

10577 Background: The BIG 1–98 and ATAC studies demonstrated that, in postmenopausal women with hormone receptor positive (HR+) early breast cancer, 5 years of initial adjuvant therapy with the aromatase inhibitors (AIs) letrozole (LET) or anastrozole (ANA) is superior to tamoxifen (TAM). The cost-effectiveness TAM, LET, and ANA have not been previously evaluated using a consistent methodology. Methods: A Markov model was used to estimate the incremental cost per quality-adjusted life year (QALY) gained with initial adjuvant therapy with LET vs TAM, ANA vs TAM, and LET vs ANA in postmenopausal women with HR+ early stage breast cancer from the US healthcare system perspective. Probabilities of recurrence (including contralateral tumor) and adverse events (endometrial cancer, thromboembolism, fractures, hypercholesterolemia, MI, and stroke) for TAM were based primarily on published US population-based studies and trials of prophylactic TAM vs placebo. Corresponding probabilities for LET and ANA were calculated by multiplying probabilities for TAM by estimated relative risks of LET vs TAM and ANA vs TAM from the BIG 1–98 and ATAC trials respectively. Other probabilities, costs, and health-state utilities were obtained from published studies. Expected lifetime costs and QALYs were estimated for a cohort of HR+ postmenopausal women with early breast cancer, aged 61 years at therapy initiation and discounted at 3% annually. Probabilistic sensitivity analyses were conducted to assess precision of results. Results: Incremental cost per QALY gained for LET vs TAM is $33,536 (95% CI $20,409 to $70,566) and for ANA vs TAM is $38,967 (95% CI $23,826 to $81,904). Compared with ANA, LET is less costly ($9,647 vs $10,190) and gains more QALYs (0.29 vs 0.26), although differences in costs (95% CI -$1,669 to $671) and QALYs (95% CI -0.16 to 0.22) are not statistically significant. Conclusions: In postmenopausal women with HR+ early breast cancer, adjuvant therapy with either LET or ANA is cost-effective from a US healthcare system perspective. Although LET dominates ANA in our base-case analysis, definitive conclusions regarding the cost-effectiveness of LET vs ANA must await results of comparative clinical studies. [Table: see text]

International comparison of the cost-effectiveness of 5 years letrozole or anastrozole compared to 5 years tamoxifen for early breast cancer in hormone receptor-positive postmenopausal women: Belgium, Canada, UK, and US analyses

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 556-556 ◽  
Author(s):  
S. Kaura ◽  
J. Karnon ◽  
F. di Trapani
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Hormone Receptor ◽  
Early Stage ◽  
Cost Effective ◽  
Hormone Receptor Positive ◽  
The Uk ◽  
The Cost ◽  
Country Specific

556 Background: The BIG1–98 and ATAC trials have proven the effectiveness of 5 years letrozole (LET) and anastrozole (ANA), respectively, compared to 5 years tamoxifen (TAM) for the treatment of postmenopausal women with hormone receptor positive (HR+) early stage breast cancer. This analysis uses similar assumptions to those used in the NICE appraisal in the UK, and country specific input data to estimate the cost-effectiveness of LET vs TAM and ANA vs. TAM from the Belgian, Canadian, UK, and US health care perspective (8 analyses). Methods: The same Markov model was used to estimate the incremental cost per quality-adjusted life year (QALY) gained (ICQ) across the 8 analyses in postmenopausal women with HR+ early stage breast cancer. Model events and assumptions were based on the analysis undertaken by the NICE appraisal team in the UK. Probabilities of breast cancer events (contralateral; locoregional; and metastases) were based on the latest early breast cancer (Lancet) overview. Country-specific cost, utility, and adverse event parameter values were informed by relevant population-based studies. LET and ANA effects were informed by published results of the BIG 1–98 and ATAC trials, which were assumed to cease after therapy discontinuation (other than fracture risk that continued for 5 further years). Costs and QALYs were estimated over the remaining lifetime of a cohort of HR+ women aged 60 yrs, discounted at 3.5% annually. Conclusion: Compared to TAM, adjuvant treatment of postmenopausal HR+ women with LET or ANA for 5 years is a cost-effective use of resources in all of the countries included in this analysis. Based on the model assumptions used by the NICE appraisal team in the UK, the mean results indicate that LET is more cost-effective than ANA, though the confidence intervals are wide. [Table: see text] No significant financial relationships to disclose.

Cost-effectiveness of the Oncotype DX Breast Recurrence Score test in postmenopausal women with node-positive early breast cancer based on the RxPONDER trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 534-534
Author(s):  
Vladislav Berdunov ◽  
Steve Millen ◽  
Andrew Paramore ◽  
Sarah Reynia ◽  
Nina Fryer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Early Breast Cancer ◽  
Distant Recurrence ◽  
Oncotype Dx ◽  
Node Positive ◽  
The Uk ◽  
The Cost ◽  
The Impact

534 Background: The Oncotype DX test is a predictive and prognostic multigene assay used to guide adjuvant chemotherapy in HR+/HER2- early breast cancer. The ability of the Oncotype DX test to predict the benefit of chemotherapy in node-positive early breast cancer was demonstrated in SWOG-8814. This evidence, in combination with findings from a bespoke analysis of the TransATAC study, informed an economic evaluation of the Oncotype DX test by the National Institute for Health and Care Excellence in the UK. This study examined the impact of new evidence from the RxPONDER trial on the cost-effectiveness of the Oncotype DX test in postmenopausal women with node-positive early breast cancer. Methods: The cost-effectiveness of the Oncotype DX test compared to clinical risk tools only in postmenopausal HR+/HER2- early breast cancer was estimated using a model in Microsoft Excel. The pre-RxPONDER analysis using the old cut points (RS 0-17, RS 18-30, RS 31-100) was informed by TransATAC and SWOG-8814. The model was updated with 5-year probability of distant recurrence as first site estimates based on new RS cut points (RS 0-25, RS 26-100) from RxPONDER. The impact on incremental lifetime costs and quality-adjusted life-years (QALYs) gained was examined based on the list price for the Oncotype DX test in the UK. Results: The impact of adding data from RxPONDER into the cost-effectiveness analysis is summarized in the table below. Conclusions: The RxPONDER trial demonstrated that the addition of chemotherapy to endocrine therapy had no benefit for distant recurrence in postmenopausal women with RS 0-25, regardless of clinical features, which suggests that most patients with 1-3 positive nodes can be safely spared adjuvant chemotherapy. In the model this was reflected in reduced cost of chemotherapy and higher QALYs from avoiding short and long-term adverse effects of chemotherapy. Targeted chemotherapy of a minority (17%) of patients with RS 26-100 reduced the cost of distant recurrence and improved survival based on the model results. RxPONDER provides direct evidence to inform the probability of distant recurrence with endocrine and chemo-endocrine therapy, whilst previous models have had to synthesize multiple sources of DRFI and chemotherapy treatment effect. Future studies should examine the impact of the RxPONDER findings on chemotherapy treatment decision-making in routine clinical practice.[Table: see text]

Sign in / Sign up

Export Citation Format

Share Document