Cost-benefit analysis of anastrazol and tamoxifen in adjuvant treatment of hormone receptor-positive, post-menopausal breast cancer
Keywords:
breast neoplasms, antineoplastic agents, hormonl, cost-benefit analysis, aromatase inhibitors, economics, pharmaceutical, Colombia
Abstract
Introduction. In high-income countries, tamoxifen has been replaced by aromatase inhibitors such as anastrozole in adjuvant hormone therapy for early breast cancer. These drugs target patients with positive hormone receptors, due to the better results achieved for disease-free survival. The cost-effectiveness of this treatment change has not been evaluated in middle income countries.Objective. The cost effectiveness of anastrozole vs tamoxifen was assessed during five-years of adjuvant treatment of hormone receptor-positive, post-menopausal early breast cancer patients.
Materials and methods. This is a literature-based analysis. The natural history of the breast cancer and the effects of treatment were modeled as a Markov process. Effectiveness was defined as disease-free survival. Transition probabilities for the disease and adverse effects were obtained from the literature. Costs were defined as the median of actual costs provided by health insurance companies and the Colombian National Cancer Institute expressed in 2007 Colombian pesos. Probabilistic sensitivity analysis was performed, along with one way sensitivity analysis was for the costs.
Results. Compared with tamoxifen, anastrazol results in an additional relapse-free period of 0.5 years. Each relapse-free year obtained by tamoxifen cost 27,210,604 pesos, or with anastrazol 37,071,337 pesos with a discount rate of 3%. The cost for a sustained-effects scenario were 23,617,400 pesos for tamoxifen and $16,140.282 for anastrazol.
Conclusions. The use of anastrazol has an additional cost per relapse-free year of 7,521,363 pesos (2007). Therefore, for postmenopausal, early breast cancer hormone receptor positive women in Colombia, the cost-effective alternative is tamoxifen used as adjuvant therapy for five years.
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References
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30. Olmos JM, Martínez J, García J, Matorras P, Moreno JJ, González-Macías J. Incidencia de fractura de cadera en Cantabria. Med Clin (Barc). 1992;99:729-31.
31. Tarasevicius S, Jermolajevas V, Tarasevicius R, Zegunis V, Smailys A, Kalesinskas RJ. Total hip replacement for the treatment of femoral neck fractures. Long-term results. Medicina (Kaunas). 2005;41:465-9.
32. Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64-71.
33. Schmoor C, Sauerbrei W, Bastert G, Schumacher M, for the German Breast Cancer Study Group. Role of Isolated locoregional recurrence of breast cáncer: results of four prospective studies. J Clin Oncol. 2000;18:1696-708.
34. Miller D, Homan SM. Determining transition probabilities: confusion and suggestions. Med Decis Making. 1994;14:52-8.
35. World Health Organization. Macroeconomics and health: investing in health for economic development: report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.
36. Banco de la República. Estadísticas. Fecha de consultado: 15 de septiembre de 2008). Disponible en www.banrep.gov.co/estad/dsbbs/srea1_008.xls.
37. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9:45-53.
38. Jönson B. Changing health environment: The challenge to demonstrate cost-effectiveness of new compounds. Pharmacoeconomics. 2004;22:5-10.
39. Earle CC, Chapman RH, Baker CS, Bell C, Sandberg E, Neuman P. Systematic overview of cost-utility assessments in oncology. J Clin Oncol. 2000;18:3302-17.
40. Hillner BE. Benefit and projected cost-effectiveness of anatrozole versus tamoxifen as initial adjuvant therapy for patients with early stage estrogen receptor-positive breast cancer. Cancer. 2004;101:1311-22.
2. Grana G. Adjuvant aromatase inhibitor therapy for early breast cancer: A review of the most recent data. J Surg Oncol. 2006;93:585-92.
3. Jones KL, Buzdar AU. A review of adjuvant hormonal therapy in breast cancer. Endocr Relat Cancer. 2004;11:391-406.
4. Bria E, Ciccarese M, Giannarelli D, Cuppone F, Nisticò C, Nuzzo C, et al. Early switch with aromatase inhibitors as adjuvant hormonal therapy for postmenopausal breast cancer: pooled-analysis of 8794 patients. Cancer Treat Rev. 2006;32:325-32.
5. Cuppone F, Bria E, Verma S, Pritchard K, Gandhi S, Carlini P, et al. Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer? Meta-analysis of randomized trials. Cancer. 2008;112:260-7.
6. Michaud LB. Adjuvant use of aromatase inhibitors in postmenopausal women with breast cancer. Am J Health Syst Pharm. 2005;62:266-73.
7. Mouridsen HT, Robert NJ. Benefit with aromatase inhibitors in the adjuvant setting for postmenopausal women with breast cancer. MedGenMed. 2005;7:20.
8. Locker G, Mansel R, Cella D, Dobrez D, Sorensen S, Gandhi S. Cost-effectiveness analysis of anastrozole versus tamoxifen as primary adjuvant therapy for postmenopausal women with early breast cancer: a US healthcare system perspective. The 5-year completed treatment analysis of the ATAC (Arimidex, tamoxifen alone or in combination) trial. Breast Cancer Res Treat. 2007;106:229-38.
9. Rocchi A, Verma S. Anastrozole is cost-effective Vs. tamoxifen as initial adyuvant therapy in early breast cancer: Canadian perspectives on the ATAC completed-treatment analysis. Support Care Cancer. 2006;14:917-27.
10. Moeremans K, Annemans L. Cost-effectiveness of anastrozole compared to tamoxifen in hormone receptor-positive early breast cancer. Analysis based on de ATAC trial. Int J Gynecol Cancer. 2006;16:576-8.
11. Kilian R, Porzsolt F. When to recommend and to pay for first-line adjuvant breast cancer treatment? A structured review of the literature. Breast. 2005;14:636-42.
12. Karnon J. Aromatase inhibitors in breast cancer. A review of cost considerations and cost effectiveness. Pharmacoeconomics. 2006;24:215-32.
13. Mansel R, Locker G, Fallowfield L, Benedict A, Jones D, On Behalf of the ATAC Trialists’ Group. Cost-effectiveness analysis of anastrozole Vs. tamoxifen in adjuvant therapy for early stage breast cancer in the United Kingdom: the 5-year completed treatment analysis of the ATAC (Arimidex, tamoxifen alone or in combination) trial. Br J Cancer. 2007;97:152-61.
14. Higa G. New generation aromatase inhibitors in breast cancer. Weighing out potential costs and beneficts. Pharmacoeconomics. 2000;2:121-32.
15. Wait S. Economic evaluation of endocrine therapy in the treatment of breast cancer. Anticancer Drugs. 1998;9:849-57.
16. Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, et al. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomized trial. Lancet. 2002;359:2131-9.
17. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, et al. ATAC Trialists’ Group. Results of the ATAC (Arimidex, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet. 2005;365:60-2.
18. Goss PE, Ingle JN, Martino S, Robert N, Muss H, Piccart M, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst. 2005;97:1262-71.
19. Jakesz R, Jonat W, Gnant M, Mittlboeck M, Greil R, Tausch C, et al. Switching of postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years’ adjuvant tamoxifen: combined results of ABCSG trial 8 and ARNO 95 trial. Lancet. 2005;366:455-62.
20. Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac L, Forbes J, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol. 2007;25:486-92.
21. Coombes RC, Kilburn LS, Snowdon CF, Paridaens R, Coleman RE, Jones SE, et al. Survival and safety of exemestane versus tamoxifen after 2-3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomized controlled trial. Lancet. 2007;369:559-70.
22. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax. 2003;58:470-83.
23. Deitcher SR, Gomes MP. The risk of venous thromboembolic disease associated with adjuvant hormone therapy for breast carcinoma: a systematic review. Cancer. 2004;101:439-49.
24. Warwick D, Williams MH, Bannister GC. Death and thromboembolic disease after total hip replacement. A series of 1,162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br. 1995;77:6-10.
25. MacDonald ND, Salvesen HB, Ryan A, Iversen OE, Akslen LA, Jacobs IJ. Frequency and prognostic impact of microsatellite instability in a large population-based study of endometrial carcinomas. Cancer Res. 2000;60:1750-2.
26. Rasmussen JN, Rasmussen S, Gislason GH, Buch P, Abildstrom SZ, Køber L, et al. Mortality after acute myocardial infarction according to income and education. J Epidemiol Community Health. 2006;60:351-6.
27. Kinoshita N, Imai K, Kinjo K, Naka M. Longitudinal study of acute myocardial infarction in the southeast Osaka district from 1988 to 2002. Circ J. 2005;69:1170-5.
28. Karagiannis A, Mikhailidis DP, Tziomalos K, Sileli M, Savvatianos S, Kakafika A, et al. Serum uric acid as an independent predictor of early death after acute stroke. Circ J. 2007;71:1120-7.
29. Kleindorfer D, Broderick J, Khoury J, Flaherty M, Woo D, Alwell K, et al. The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. Stroke. 2006;37:2473-8.
30. Olmos JM, Martínez J, García J, Matorras P, Moreno JJ, González-Macías J. Incidencia de fractura de cadera en Cantabria. Med Clin (Barc). 1992;99:729-31.
31. Tarasevicius S, Jermolajevas V, Tarasevicius R, Zegunis V, Smailys A, Kalesinskas RJ. Total hip replacement for the treatment of femoral neck fractures. Long-term results. Medicina (Kaunas). 2005;41:465-9.
32. Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL. Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res. 2004;425:64-71.
33. Schmoor C, Sauerbrei W, Bastert G, Schumacher M, for the German Breast Cancer Study Group. Role of Isolated locoregional recurrence of breast cáncer: results of four prospective studies. J Clin Oncol. 2000;18:1696-708.
34. Miller D, Homan SM. Determining transition probabilities: confusion and suggestions. Med Decis Making. 1994;14:52-8.
35. World Health Organization. Macroeconomics and health: investing in health for economic development: report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.
36. Banco de la República. Estadísticas. Fecha de consultado: 15 de septiembre de 2008). Disponible en www.banrep.gov.co/estad/dsbbs/srea1_008.xls.
37. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9:45-53.
38. Jönson B. Changing health environment: The challenge to demonstrate cost-effectiveness of new compounds. Pharmacoeconomics. 2004;22:5-10.
39. Earle CC, Chapman RH, Baker CS, Bell C, Sandberg E, Neuman P. Systematic overview of cost-utility assessments in oncology. J Clin Oncol. 2000;18:3302-17.
40. Hillner BE. Benefit and projected cost-effectiveness of anatrozole versus tamoxifen as initial adjuvant therapy for patients with early stage estrogen receptor-positive breast cancer. Cancer. 2004;101:1311-22.
How to Cite
1.
Gamboa Óscar, Díaz S, Chicaíza L, García M. Cost-benefit analysis of anastrazol and tamoxifen in adjuvant treatment of hormone receptor-positive, post-menopausal breast cancer. Biomed. [Internet]. 2010 Mar. 1 [cited 2025 Apr. 4];30(1):46-55. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/152
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