Pharmacoeconomic analysis of adjuvant therapy with exemestane, anastrozole, letrozole or tamoxifen in postmenopausal women with operable and estrogen receptor-positive breast cancer

Abstract

The EXE scheme after TAM is more cost-effective than the ANA and LET schemes.

Reviewing the Cost-Effectiveness of Endocrine Early Breast Cancer Therapies: Influence of Differences in Modeling Methods on Outcomes

“…Incremental LYs gained varied between 0.103 [36] and 1.046 [25] and incremental QALYs gained varied between 0.120 [36] and 0.566 [25]. Cost of 1 LY gained was found to vary between €8,451 [37] and €46,072 [25], and the cost of 1 QALY gained varied between €12,871 [37] and €72,112 [25].…”

“…All studies used the ATAC trial [32] to obtain transition probabilities and were performed from a health-care payer perspective. Incremental life-years (LYs) gained ranged from 0.16 [26] to 0.550 [24], with an ICER ranging from €3,958 [28] to €75,331 [25]. Incremental quality-adjusted LYs (QALYs) gained ranged from 0.092 [30] to 0.378 [28], with a cost per QALY gained varying from €3,696 [28] to €120,265 [25].…”

“…The cost-effectiveness of switching to exemestane after 2 to 3 years of therapy with tamoxifen compared to continuing tamoxifen was determined in five selected studies [25,[35][36][37][38]. All studies used the Intergroup Exemestane Study [33], and one also used the SEERMedicare data [37] to obtain probabilities, and two analyses used the health-care payer perspective [25,36], and for two, it was unclear [35,37]; however, because only direct costs were included, we assumed that a health-care payer perspective was used.…”

“…All studies used the Intergroup Exemestane Study [33], and one also used the SEERMedicare data [37] to obtain probabilities, and two analyses used the health-care payer perspective [25,36], and for two, it was unclear [35,37]; however, because only direct costs were included, we assumed that a health-care payer perspective was used. Incremental LYs gained varied between 0.103 [36] and 1.046 [25] and incremental QALYs gained varied between 0.120 [36] and 0.566 [25]. Cost of 1 LY gained was found to vary between €8,451 [37] and €46,072 [25], and the cost of 1 QALY gained varied between €12,871 [37] and €72,112 [25].…”

“…The individual studies applied a time horizon of 7.5 [36], 10 [25,30], 20 [25,26,28 -30], 25 [14,15,31], 30 [17,18,39], 35 [37], 40 [41], 50 years [27], or lifetime [16,24,35,38,40] (see Table 3 for an overview per therapy group).…”