Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in postmenopausal women with hormone-receptor positive early breast cancer from a Canadian perspective

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dc.contributor.authorDelea, T.
dc.contributor.authorEl-Ouagari, K.
dc.contributor.authorKarnon, J.
dc.contributor.authorSofrygin, O.
dc.date.issued2008
dc.descriptionThe original publication can be found at www.springerlink.com
dc.description.abstractBackground In the primary core analysis of BIG 1–98, a randomized, double-blind trial comparing 5 years of initial adjuvant therapy with letrozole versus tamoxifen in postmenopausal women with hormone receptor-positive (HR+) early breast cancer, letrozole significantly improved disease-free survival by 19% and reduced the risk of breast cancer recurrence by 28% and distant recurrence by 27%. Methods A Markov model was used to estimate the incremental cost per quality-adjusted life year (QALY) gained with 5 years of initial adjuvant therapy with letrozole versus tamoxifen from a Canadian healthcare system perspective. Probabilities of recurrence and side effects for tamoxifen were based on published results of BIG 1–98 and other published population-based studies. Corresponding probabilities for letrozole were calculated by multiplying probabilities for tamoxifen by estimated relative risks for letrozole versus tamoxifen from BIG 1–98. Other probabilities, costs of breast-cancer care and treatment of side effects, and health-state utilities were obtained from published studies. Costs and QALYs were estimated over the lifetime of a cohort of postmenopausal women with HR+ early breast cancer, aged 60 years at initiation of therapy, and discounted at 5% annually. Results Compared with tamoxifen, letrozole yields an additional 0.368 life-years (12.453 vs. 12.086) and 0.343 QALYs (11.582 vs. 11.239). These benefits are obtained at an additional cost of $Can 8,110 ($Can 30,819 vs. $Can 22,709). Cost per QALY gained for letrozole versus tamoxifen is $Can 23,662 (95% CI $Can 15,667–$Can 52,014). Conclusion In postmenopausal women with HR+ early breast cancer, initial adjuvant treatment with letrozole is cost-effective from the Canadian healthcare system perspective.
dc.description.statementofresponsibilityThomas E. Delea, Khalid El-Ouagari, Jonathan Karnon and Oleg Sofrygin
dc.identifier.citationBreast Cancer Research and Treatment, 2008; 108(3):375-387
dc.identifier.doi10.1007/s10549-007-9607-7
dc.identifier.issn0167-6806
dc.identifier.issn1573-7217
dc.identifier.orcidKarnon, J. [0000-0003-3220-2099]
dc.identifier.urihttp://hdl.handle.net/2440/47478
dc.language.isoen
dc.provenancePublished online: 26 July 2007
dc.publisherKluwer Academic Publ
dc.source.urihttp://www.springerlink.com/content/r807673286r4j409/
dc.subjectAdjuvant therapy
dc.subjectBreast cancer
dc.subjectCost-effectiveness
dc.subjectLetrozole
dc.subjectTamoxifen
dc.titleCost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in postmenopausal women with hormone-receptor positive early breast cancer from a Canadian perspective
dc.typeJournal article
pubs.publication-statusPublished

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