No abstract

Study (IES). Health effects were expressed in terms of quality adjusted life years (QALYS). Direct medical costs were obtained from the governmental hospitals in Egypt. All costs and effects were discounted at 3.5% annually according to the Egyptian pharmacoeconomic guidelines. Deterministic sensitivity analyses were conducted. Results: The study revealed that Exemestane yielded an additional gain of 0.23 QALYs at lower cost estimated by EGP 24,976 than Tamoxifen over 15-years, Exemestane is the dominant therapy. Deterministic sensitivity analyses indicated that the transition probability between health states of no recurrence to distant metastasis for Exemestane arm had the greatest impact on the results. ConClusions: Exemestane 25mg is a cost saving strategy compared to Tamoxifen 20mg in post-menopausal women with early breast cancer.

Objectives: Stratified breast cancer screening describes the using of individual risk information to cluster women into groups who would overall benefit from intensified screening and groups who would overall benefit from reduced screening. Recent economic evaluations applied decision analytical modeling to test new methods of stratified mammography screening for women over 50 years. One major assumption in recent models is that women adhere fully to recommended screening protocols. In Germany, screening adherence is at 54%. Accordingly, full adherence is more the exception than the rule. We evaluate stratified breast cancer screening for the general population using both, full adherence and non-adherence, assumptions. MethOds: A micro-simulation Markov model is adapted to the German context. Model validation is based on the AdViSHE tool. German register and published data are used for parameters of cancer incidence, treatment and survival. Annual, biennial and triennial routine screening are compared against five strategies using different combination of three risk factor to stratify screening frequencies. As suggested in the German HTA procedure, all strategies are evaluated using efficiency frontiers. We evaluated three outcome variables (mortality reduction, QALY and false positive results) under the assumption of full adherence and an average adherence rate of 54%. Results: Under the full adherence assumption, four of five stratified strategies and all routine strategies lie on the efficiency frontiers. Only one stratified strategies is dominated. Under the non-adherence assumption, biennial routine screening and two more stratified screening are dominated in mortality reduction and QALYs. Depending on the willingness-to-pay, one of the two remaining stratified screening should be selected as efficient alternatives to biennial routine screening. cOnclusiOns: Routine and stratified screening strategies are found to be sensitive to non-adherence. The choice which strategy to recommend is affected by non-adherence. In the context of low screening adherence, routine mammography screening is not an efficient strategy.