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Type: Journal article
Title: A trial-based cost-effectiveness analysis of letrozole followed by tamoxifen versus tamoxifen followed by letrozole for postmenopausal advanced breast cancer
Author: Karnon, J.
Johnston, S.
Jones, T.
Glendenning, A.
Citation: Annals of Oncology, 2003; 14(11):1629-1633
Publisher: Oxford Univ Press
Issue Date: 2003
ISSN: 0923-7534
Statement of
J. Karnon, S. R. D. Johnston, T. Jones and A. Glendenning
Abstract: Background: Third-generation aromatase inhibitors are being considered as an alternative to tamoxifen as first-line therapy for advanced breast cancer. These newer therapies are more expensive, and will gain greater acceptance if they can demonstrate cost-effectiveness. Methods: Life table analyses are used to compare the costs and benefits [life years gained and quality-adjusted life years (QALYs) gained] of treating postmenopausal women with advanced breast cancer with first-line letrozole (with the option of second-line tamoxifen) compared with first-line tamoxifen (with the option of second-line letrozole). Patient-level data from a large clinical trial describes the effectiveness of the therapy options, clinicians estimate resource usage and utility values are obtained from the literature. Results: The mean cost of providing first- and second-line hormonal therapy is £4765 if letrozole is the first-line therapy and £3418 if tamoxifen is provided first (a difference of £1347). However, patients receiving letrozole as first-line therapy gain an additional 0.228 life years, or 0.158 QALYs. The cost-effectiveness analysis found that first-line hormonal therapy with letrozole gains additional life years at a cost of £5917, whilst the cost per additional QALY gained is £8514. Conclusion: The strategy of letrozole as first-line hormonal therapy not only provides an opportunity for extending and improving patient’s quality of life, but also is highly cost-effective compared with other generally accepted medical treatments.
Keywords: advanced breast cancer
Rights: Copyright © 2003 European Society for Medical Oncology
DOI: 10.1093/annonc/mdg447
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