Cost-effectiveness analysis of fulvestrant versus anastrozole as first-line treatment for hormone receptor-positive advanced breast cancer

Ding, Haiying; Fang, Luo; Xin, Wenjuan; Tong, Ying; Zhou, Qiuping; Huang, Ping

doi:10.1111/ecc.12733

Cited by 19 publications

(14 citation statements)

References 19 publications

(28 reference statements)

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“…Another three studies did not clearly describe methods used to estimate healthcare resources and their unit costs. Two studies did not report the dates of the estimated resource quantities and unit costs (N=2, 13.3%) [26],[27]. Seven studies included a figure of the model but no justification for the analytic approach (N=7, 46.67%) and four studies included neither a figure nor a justification (N=4, 26.67%).…”

Section: Resultsmentioning

confidence: 99%

An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

Gogate

Rotter

Trogdon

et al. 2019

Breast Cancer Res Treat

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Objective: The goal of this systematic review is to provide an update to the review by Pouwels et al. by conducting a systematic review and an assessment of the reporting quality of the economic analyses conducted since 2014. Methods: This systematic review identified published articles focused on metastatic breast cancer treatment using the Medline/PubMed and Scopus databases and the following search criteria: (((cost effectiveness[MeSH Terms]) OR (cost effectiveness) OR (cost-effectiveness) OR (cost utility) OR (cost-utility) OR (economic evaluation)) AND ((“metastatic breast cancer”) OR (“advanced breast cancer”))). The reporting quality of the included articles was evaluated using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Of the 256 identified articles, 67 of the articles were published after October 2014 when the prior systematic review stopped its assessment [1]. From the 67 articles, we narrowed down to include 17 original health economic analyses specific to metastatic or advanced breast cancer. These articles were diverse with respect to methods employed and interventions included. Conclusion: Although each of the articles contributed their own analytic strengths and limitations, the overall quality of the studies was moderate. The review demonstrated that the vast majority of the reported incremental cost-effectiveness ratios exceeded the typically employed willingness to pay thresholds used in each country of analysis. Only three of the reviewed articles studied chemotherapies rather than treatments targeting either HER2 or hormone receptors, demonstrating a gap in the literature.

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Section: Resultsmentioning

confidence: 99%

An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

Gogate

Rotter

Trogdon

et al. 2019

Breast Cancer Res Treat

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“…Previous studies have assessed the cost-effectiveness of FUL versus ANA monotherapy in first-line treatment of MBC in China, 17 30 whereas no economic evaluation of the combination of aforementioned endocrine therapy in PMW-MBC (HR+) has been published in the literature. In the absence of direct head-to-head studies of FUL versus F&A, we conducted indirect comparisons of the S0226 and FIRST trial results with the same enrolled and exclusive criteria.…”

Section: Discussionmentioning

confidence: 99%

“…In the model, probabilities from progression free state to death were assumed to be the same as the natural mortality rate, obtained as the age-specific and sex-specific death rate from the life tables for the Chinese populations. 17 …”

Section: Methodsmentioning

confidence: 99%

Half-dose fulvestrant plus anastrozole as a first-line treatment for hormone receptor-positive metastatic breast cancer: a cost-effectiveness analysis

et al. 2020

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ObjectiveThe S0226 trial demonstrated that the combination of half-dose fulvestrant (FUL) and anastrozole (ANA) (F&A) caused a significant improvement in overall survival (OS) versus ANA monotherapy for first-line treatment of postmenopausal women with hormone receptor-positive metastatic breast cancer (PMW-MBC (HR+)). The objective of this study was to evaluate the cost-effectiveness of F&A in the first-line treatment for PMW-MBC (HR+) in China.DesignWe constructed a Markov model over a life-time horizon. The clinical outcomes and utility data were obtained from published literature. Cost data were obtained from official Chinese websites. Sensitivity analyses were performed to test result uncertainty.SettingChinese healthcare system perspective.PopulationA hypothetical cohort of adult patients presenting with PMW-MBC (HR+).InterventionsF&A compared with full-dose FUL and ANAmonotherapy.Main outcome measuresThe main outcome of this study was the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALY).ResultsANA was estimated to have the lowest cost and minimum life-years. The ICER of F&A versus ANA was US$15 665.891/QALY with incremental cost and QALY of US$12 401.120 and 0.792, respectively, which was less than the willingness-to-pay of US$29 383/QALY. Compared with F&A, FUL yielded a higher cost and a shorter lifetime; hence, it was identified as a dominated strategy. The univariate sensitivity analysis indicated the price of FUL was the most influential factor in our study. The probability that F&A was cost-effective at a threshold of US$29 383/QALY in China was 86.5%.ConclusionF&A is a cost-effective alternative to FUL and ANA monotherapy for the first-line treatment of PMW-MBC (HR+) in China. F&A is a promising first-line treatment for PMW-MBC (HR+), and more research is needed to evaluate the economy of using F&A in other countries.

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“…However, there are no firmly established second-and later-line endocrine therapies for postmenopausal women with hormone receptor-positive metastatic breast cancer. Moreover, the cost-effectiveness of these new endocrine and targeted therapies is still debated given their relatively high cost and lack of definitive evidence for superior efficacy [9,10]. Further, these regimens have numerous side effects.…”

Section: Introductionmentioning

confidence: 99%

High-Dose Toremifene as a Promising Candidate Therapy for Hormone Receptor-Positive Metastatic Breast Cancer with Secondary Resistance to Aromatase Inhibitors

Fushimi

Tabei

Fuke

et al. 2020

International Journal of Breast Cancer

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There are currently no established second- and later-line therapies for postmenopausal women with hormone receptor-positive advanced or metastatic breast cancer. We examined the efficacy of high-dose toremifene (HD-TOR) for this patient group and whether aromatase inhibitor (AI) resistance influences HD-TOR treatment outcome. This retrospective analysis investigated the outcomes of 19 women with postmenopausal hormone-sensitive recurrent or metastatic breast cancer who received HD-TOR, defined as 120 mg daily from 2012 to 2016. The median follow-up duration was 9.67 months. The overall response rate (ORR) and clinical benefit rate (CBR) were compared between various clinical subgroups, including patients exhibiting primary or secondary AI resistance as defined by the timing of recurrence or progression. Time to treatment failure (TTF) was estimated by the Kaplan–Meier method and compared between subgroups by the log-rank test. The overall ORR was 21.1%, and the CBR was 31.6%. CBR was significantly higher for patients without liver metastasis (50% vs. 0%, p=0.044). Nine cases exhibited primary and eight cases secondary AI resistance. Both ORR and CBR were higher in patients with secondary AI resistance (25% vs. 0%, p=0.087; 38% vs. 11%, p=0.29). The median TTF was 6.2 months in the entire AI-resistant group (n=17) and was longer in the secondary resistance subgroup than in the primary resistance subgroup (8.40 vs. 4.87 months; log-rank: p=0.159). High-dose TOR appears to be most effective for postmenopausal breast cancer cases with secondary resistance to AIs, cases without prior AI treatment, and cases without liver metastasis. The detailed mechanisms of AI resistance and the clinical features of responsive cases need to be further clarified to identify the best candidates for HD-TOR.

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Cost-effectiveness analysis of fulvestrant versus anastrozole as first-line treatment for hormone receptor-positive advanced breast cancer

Cited by 19 publications

References 19 publications

An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

Half-dose fulvestrant plus anastrozole as a first-line treatment for hormone receptor-positive metastatic breast cancer: a cost-effectiveness analysis

High-Dose Toremifene as a Promising Candidate Therapy for Hormone Receptor-Positive Metastatic Breast Cancer with Secondary Resistance to Aromatase Inhibitors

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