Cost-Benefit Analysis of Endocrine Therapy in the Adjuvant Setting for Postmenopausal Patients with Hormone Receptor-Positive Breast Cancer, Based on Survival Data and Future Prices for Generic Drugs in the Context of the German Health Care System

Abstract

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.

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

“…This confirms that the introduction of the DRG system has led to the incorporation of DRG-implicated economic aspects and concepts into daily medical care. However many cost-effectiveness analyses are not helpful from the care providers' perspective because they often take an overall approach from a society's perspective [1], not explicitly addressing that cost-effective therapy might not be cost-covering for the clinic and care provider at all. In summary, the references found represent only partially the actual effect and influence of economic aspects in hospitals on breast cancer treatment within the last decade.…”

Economic modeling of risk-adapted screen-and-treat strategies in women at high-risk for breast or ovarian cancer

“…10% have a tumor stage so advanced that primary cyto-reductive surgery is not performed. Additional costs for potential postoperative complications were not included [36,37].…”

Management of advanced lung cancer in resource-constrained settings: a perspective from India

“…Generic brands for chemotherapeutic agents as well as molecularly targeted drugs appear to be more affordable for the general population of LC patients in RCSs compared with the innovator brands. Although there are no published studies related to LC, generic drugs have been shown to be as effective as (both in vitro and in clinical practice) and more cost effective than innovator brands for breast, gynecological and colorectal cancers [112][113][114][115]. A 12-year review of bioequivalence studies by the US FDA showed that the mean difference between innovator drugs from their generic substitutes was less than 5% [116].…”