CYP2D6*10 pharmacogenetic-guided SERM could be a cost-effective strategy in Chinese patients with hormone receptor-positive breast cancer

2020 ◽  
Vol 21 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Xiaoxia Wei ◽  
Jiaqin Cai ◽  
Jie Zhuang ◽  
Bin Zheng ◽  
Yuxia Sui ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Hormone Receptor ◽  
Cost Effective ◽  
Chinese Patients ◽  
Hormone Receptor Positive ◽  
Receptor Modulator ◽  
The Cost ◽  
Quality Adjusted Life ◽  
Positive Breast Cancer

Aim: To assess the cost–effectiveness of CYP2D6*10 genetic testing for the management of Chinese women with hormone receptor-positive (HR+) breast cancer treated with selective estrogen receptor modulator. Methods: A Markov model was developed to evaluate a total expected cost and an incremental cost-effectiveness ratio (ICER). Robustness of the model was addressed in one-way analyses and probabilistic sensitivity analysis. Results: The cost of strategies of tamoxifen, toremifene without genotyping and the strategy base on CYP2D6*10 genotype were $63,879.19, $90,156.60 and $95,021.41, and the quality-adjusted life years gained are 8.1588, 12.89687 and 13.85911, respectively. The incremental cost-effectiveness ratio of the CYP2D6*10 testing versus toremifene were 5,055.74221/quality-adjusted life year, respectively. Conclusion: CYP2D6*10 pharmacogenetic-guided selective estrogen receptor modulator can be a cost-effective strategy in the Chinese patients with hormone receptor-positive breast cancer.

Cost–effectiveness analysis of ribociclib plus fulvestrant for hormone receptor-positive/human EGF receptor 2-negative breast cancer

Immunotherapy ◽  
2021 ◽  
Author(s):  
Wei Jiang ◽  
Zhichao He ◽  
Tiantian Zhang ◽  
Chongchong Guo ◽  
Jianli Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Hormone Receptor ◽  
Egf Receptor ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Effectiveness Ratio ◽  
Hormone Receptor Positive ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To evaluate the cost–effectiveness of ribociclib plus fulvestrant versus fulvestrant in hormone receptor-positive/human EGF receptor 2-negative advanced breast cancer. Materials & methods: A three-state Markov model was developed to evaluate the costs and effectiveness over 10 years. Direct costs and utility values were obtained from previously published studies. We calculated incremental cost–effectiveness ratio to evaluate the cost–effectiveness at a willingness-to-pay threshold of $150,000 per additional quality-adjusted life year. Results: The incremental cost–effectiveness ratio was $1,073,526 per quality-adjusted life year of ribociclib plus fulvestrant versus fulvestrant. Conclusions: Ribociclib plus fulvestrant is not cost-effective versus fulvestrant in the treatment of advanced hormone receptor-positive/human EGF receptor 2-negative breast cancer. When ribociclib is at 10% of the full price, ribociclib plus fulvestrant could be cost-effective.

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 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]

Cost-effectiveness of adjuvant radiotherapy for older women with early hormone-receptor positive breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6096-6096
Author(s):  
Katherine Elizabeth Reeder-Hayes ◽  
Stephanie B. Wheeler ◽  
Andrea K Biddle
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Breast Conserving Surgery ◽  
Stage I ◽  
Hormone Receptor Positive ◽  
The Cost ◽  
Quality Adjusted Life

6096 Background: Radiation therapy (XRT) following breast conserving surgery decreases local recurrence at the expense of additional morbidity and treatment costs. However, its utility in elderly women at low risk of recurrence has been questioned. This study assessed the cost-effectiveness of adding XRT to hormonal therapy (HT) in women over 70 with stage I, hormone-receptor positive (HR+) breast cancer after breast conserving surgery. Methods: A decision tree model was used to assess the costs and benefits of XRT + HT versus HT alone in 10,000 women age 70+ with stage I HR+ breast cancer. Using a societal perspective, we considered medical costs and quality of life effects of initial treatment, recurrences, and metastatic disease as well as long-term XRT-associated complications including breast fibrosis, chronic pneumonitis and cardiac disease. Probabilities of recurrence and death were modeled on recent clinical trial results, while toxicity probabilities were taken from literature review. The primary health outcome was incremental quality-adjusted life years (QALYs) gained. One-way and probabilistic sensitivity analyses (PSA) were performed to assess the sensitivity of model results and conclusions to various parameter estimates. Results: In the base-case scenario, the incremental cost-effectiveness ratio (ICER) for the addition of XRT was $923,017/QALY. The ICER was highly sensitive to variations in utility weights, particularly those reflecting patient preferences for initial treatment with or without XRT and those reflecting the decrement in quality of life resulting from breast fibrosis. In PSA, XRT was associated with lower quality-adjusted life expectancy at higher cost in 58% of simulations. Conclusions: In women over 70 with stage I HR+ breast cancer, the addition of XRT to HT is not cost-effective at a willingness-to-pay threshold of $100,000/QALY, and is associated with little or no improvement in quality-adjusted life expectancy. Providers should be aware that the cost-effectiveness of XRT in this population is strongly influenced by patient preferences surrounding recurrence and toxicity risks, and should weigh these factors when making shared decisions with patients.

Sign in / Sign up

Export Citation Format

Share Document