Cost–effectiveness of letrozole, anastrozole and exemestane for early adjuvant breast cancer

Clinical trials have shown aromatase inhibitors to be a more effective hormonal therapy for preventing recurrence in postmenopausal women with hormone receptor-positive early breast cancer. However, the aromatase inhibitors have an alternative adverse event profile and are more expensive than tamoxifen. This review identifies 15 separate cost–effectiveness analyses that have assessed the incremental cost per quality-adjusted life year gained of one or more aromatase inhibitor treatment strategies compared with tamoxifen. We found many similarities between the studies and the overriding conclusion was that the aromatase inhibitor strategies are cost effective relative to 5-year tamoxifen treatment. This conclusion is shared by the National Institute for Clinical Excellence in the UK. Comparisons between the aromatase inhibitors are hampered as none of the clinical trials included a direct comparison, although an ongoing trial is addressing this issue.