Background: Cost-effectiveness analyses have focused on aromatase inhibitors (AIs), but the results are inconsistent and disease-free survival has often been extrapolated to overall survival. The present study calculates the cost-effectiveness of 5 years of letrozole versus tamoxifen versus anastrozole in the context of the German health care system, using survival data from the Breast International Group (BIG) 1-98 study and the Arimidex, Tamoxifen, Alone or in Combination (ATAC) study and generic prices. Materials and Methods: A hybrid model was developed that incorporates recurrence rates, overall survival, treatment costs and treatment-associated adverse events and the resulting costs. The basic assumption was that generic anastrozole would lead to a price reduction to 75% of the original price. Further analyses were carried out with 50% and 25% of the original prices for anastrozole and letrozole. Results: The cost-benefit model showed a gain of 0.3124 or 0.0659 quality-adjusted life years (QALYs) for letrozole or anastrozole. Incremental costs of € 29,375.15/QALY for letrozole (100% of original price) were calculated and € 94,648.03/QALY for anastrozole (75% of original price). Marked increases in cost-effectiveness are observed with further decreases in price (anastrozole: 50% price € 54,715.17/QALY, 25% price € 14,779.57/QALY; letrozole 75% price € 20,988.59/QALY, 50% price € 12,602.03/QALY, 25% price € 4,215.46/QALY). Conclusion: The present model including the inverse probability of censoring weighted analysis (IPCW) for letrozole and generic prices for both AIs shows that letrozole is cost effective.
Background: The ABCSG-12 trial investigated the efficacy of gonadotropin-releasing hormone (GnRH)analogs in combination with tamoxifen or anastrozole ± zoledronic acid (4 mg, q6m for 3 years) in 1,803 premenopausal women with hormone receptor-positive (HR+) breast cancer. After 48 months of follow-up, there was a 36% improvement in the disease-free survival (DFS) (recurrence-free survival 35%) using zoledronic acid. Based on these data, the costutility of zoledronic acid was calculated for the German healthcare system. Materials and Methods: Costs of surveillance, adverse effects, recurrence, contralateral breast cancer, metastasis, and end-of-life care were determined based on the Einheitlicher BewertungsmaΒstab (EBM 2009) and the diagnosis-related groups (DRG) system. Utilities were surveyed with a questionnaire (n = 95). Estimation of the cost-utility was made by calculating the incremental costeffectiveness ratio (ICER) per quality-adjusted life year (QALY), using a Markov model. Results: Including zoledronic acid as adjuvant therapy for 3 years resulted in total costs of € 2,262. The use of zoledronic acid is dominant when clinical efficacy and quality of life are taken into consideration (– € 45.83/QALY) (95% confidence interval (CI) – € 1,838 to E 2,375; 0.02–0.41 QALY). The sensitivity analyses present with a probability of 90% that the cost per QALY gained are <€ 22,000. Conclusion: In the German healthcare system, zoledronic acid is a cost-effective option for premenopausal patients with HR+ breast cancer.
SUMMARY
Thirty‐six patients who had had shunts for hydrocephalus between 14 and 36 years ago, and their parents and siblings were interviewed about the effects of chronic illness on their lives. Despite reports of severe financial, physical and emotional stress, most judged the quality of their family relationships and lives to be good. General outcome was poorest for those with unfavourable medical outcomes and/or questionable prospects for future independence. Almost all respondents were satisfied with the level and duration of treatment they had received.
RÉSUMÉ
La vie avec une affection chronique: étude rétrospective de patients valves pour hydrocéphalic et de leurs families
Trente‐six patients, valvés pour hydrocéphalic de 14 à 36 ans auparavant, leurs parents et fratries ont été interrogés sur les effets d'une affection chronique dans leur vie. En dépit de difficultés graves, financières physiques et affectives, la majorité jugeaient bonne la qualité de leurs relations familiales et de leur vie. Le devenir général était moins bon en cas de devenir médical défavorable et/ou des inquiétudes pour l'indépendance future. Presque tous les interrogés étaient satisfaits du niveau et de la durée du traitement dont ils avaient bénéficié.
ZUSAMMENFASSUNG
Mit chronischer Krankheit leben: eine retrospektive Studie über Hydrocephaluspatienten mit Ventil und ihre Familien
36 Patienten, die vor 14 bis 36 Jahren wegen Hydrcephalus ein Ventil hatten, und ihre Eltern und Geschwister wurden über die Auswirkung der chronischen Krankheit auf ihr Leben befragt. Trotz einiger Berichte über schwere finanzielle, physische und emotionale Belastungen, beurteilten die meisten die Qualität ihrer familiären Beziehungen und ihres Lebens als gut. Der allgemeine Outcome war für die am schlechtesten, die eine ungünstige medizinische Prognose und/oder eine fragliche Aussicht auf eine mögliche Selbstständigkeit hatten. Fast alle Befragten waren mit der Qualität und der Dauer der Behandlung, die sie erhalten hatten, zufrieden.
RESUMEN
Viviendo con una enfermedad crónica: estudio retrospective de pacientes con derivación por hidrocefalia y de sus familias
Treinta y seis pacientes con derivación por hidrocefalia practicada de 14 a 36 años antes, asi como sus padres y hermanos fueron entrevistados acerca de los efectos sobre sus vidas de la enfermedad crónica padecida. A pesar de haber referido problemas financieros, físicos y emocionales, la mayoria juzgaba que la calidad de las relaciones familiares y sus vidas eran buenas. El curso general era más pobre en los que tenian un curso médico desfavorable y/o una perspectiva dudosa para su independencia futura. Casi todas las respuestas se mostraban satisfechas con el nivel y la duración del tratamiento que habían recibido.
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