P179- Comparison of the cost per distant disease free year gained of upfront letrozole or anastrozole, or switched exemestane versus tamoxifen for early breast cancer in hormone receptor positive (HR+) postmenopausal women: the UK perspective

Jonathan Karnon, S Kaura, F di Trapani

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Due to subsequent poor prognosis, prevention of distant
recurrence (DR) is a primary aim of adjuvant hormonal therapy for early
breast cancer. Compared to 5 years TAM in postmenopausal women with
hormone receptor positive (HR+) breast cancer, BIG 1−98 estimated a
DR relative risk (RR) of 0.73 (95% CI: 0.6−0.88) for 5 years letrozole
(LET), ATAC demonstrated an RR of 0.84 (95% CI: 0.7−1.0) for 5 years
anastrozole (ANA), and IES showed an RR of 0.73 (95% CI: 0.59−0.9) for
2−3 yrs exemestane (EXE) after 2−3 years TAM. This analysis evaluates
the incremental cost per distant disease free year gained from a UK
NHS perspective of 5 years LET, 5 years ANA, or 3 years EXE (after
2 years TAM) versus 5 years TAM using the same health economic model.
Methods: A Markov model was used to describe pathways through relevant
health states over the remaining lifetime of a cohort of HR+ women aged
61 yrs. Probabilities of breast cancer events (contralateral; locoregional;
soft tissue, bone, and visceral metastases) adverse events (endometrial
cancer, hip and other fractures, cardiovascular disease, thromboembolic
events, and arthralgia) were based on the latest early breast cancer
overview, published results of the BIG 1−98, ATAC, and IES trials, and
UK population-based studies as appropriate. Conservatively, no carry-over
effect was assumed for the AIs after therapy discontinuation. Costs (2005
UK£) of breast-cancer care were obtained from a primary costing study
in Scotland, and treatment costs for AEs were obtained from published
studies. Costs and DR-free years were discounted at 3.5% annually.
Results: The mean durations of DDFS were estimated to be 12.81 years
for patients receiving 5 years LET, 12.66 years for 5 years ANA, 12.57 years
for sequential TAM and EXE, and 12.35 years for 5 years TAM. The
incremental cost per distant disease free year gained of LET vs TAM is
£10,379 (95% CI: £5,286−17,818), of ANA vs TAM is £11,428 (95% CI:
£5,071−48,856), and of sequential TAM and EXE vs TAM alone is £11,020
(95% CI: £4,820−36,947).
Conclusion: Compared to 5 years TAM, adjuvant treatment of postmenopausal
HR+ women with an AI is a cost-effective use of UK NHS
resources. The results indicate that there is overlap between the costeffectiveness
ratios for the three AI options compared to TAM. Based on
the mean results, LET appears to be the most cost-effective of the three
AIs, despite its higher acquisition cost compared to ANA in the UK.
Original languageEnglish
Pages (from-to)S64
JournalBreast
Volume16
Issue numberSupplement 1
DOIs
Publication statusPublished - 16 Mar 2007
Externally publishedYes

Keywords

  • cost
  • breast cancer
  • adverse events

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