Objective:
Breast cancer is the most common cancer in women, with more than one million cases and nearly 600,000 deaths occurring worldwide annually. Around 23,000 postmenopausal women will be diagnosed with oestrogen receptor-positive early breast cancer every year. Adjuvant endocrine therapy plays an important role in the management of hormone-receptor-positive early breast cancer, and has increased life expectancy for millions of women.
For more than 20 years, tamoxifen was the standard adjuvant (postoperative) endocrine treatment for hormone receptor-positive (i.e.,endocrine-responsive) early breast cancer. Its widespread use has had a marked effect on reducing the recurrence rate and associated mortality in hormone receptor-positive tumours that comprise about 75% of breast cancers. In recent years, the third-generation aromatase inhibitors(anastrozole, exemestane, and letrozole) have emerged as effective alternatives to tamoxifen in the early disease setting. Anastrozole , a nonsteroidal, third-generation aromatase inhibitor administered orally once daily, has shown efficacy in the treatment of postmenopausal women with early-stage hormone-sensitive breast cancer. Anastrozolr has been evaluated clinically in a wide range of breast cancer treatment settings. Although it appears to have clinical superiority, it is more expensive than the therapies (primarily tamoxifen) it has been compared with, thus economic evaluation is required to consider its incremental value to the payer.
The objectives of this review were to establish the cost-effectiveness of anastrozole compared with tamoxifen in the adjuvant treatment of early oestrogen receptor-positive breast cancer in postmenopausal women with oestrogen receptor-positive early-stage breast cancer.
Methods:
A systematic literature review was conducted to identify peer-reviewed full economic evaluations of endocrine treatments of early breast cancer published in the English language between 2004 and 2014. Information from these publications was abstracted regarding outcome, quality, and modeling methods.
Search strategy: To identify all cost-effectiveness and cost-utility analyses of tamoxifen and anastrozole, I searched Pubmed and Web of Science. The following (shortened) search string was used (“tamoxifen” [all fields]) AND (“anastrozole” [all fields]) AND (“cost” [all fields]) AND (“early” [all fields]) AND (“breast cancer” [all fields]).
Selection criteria: inclusion criteria: 1) the article was published between 2004 and 2014; 2) the article was published in English because papers in English are accessible to
academic readers all over the world; 3)the articles in which the two treatments were available; 4)the study focused on the treatment of early breast cancer; 5)the focus of the study was on determining the cost-effectiveness or cost-utility of drug treatment. exclusion criteria: 1) reviews of primary studies or systematic reviews; 2)other articles that did not meet the inclusion criteria.
Data extraction: I developed a data extraction sheet in Excel that was discussed extensively with all authors to obtain all relevant data. Information was extracted from each included study on author, publication year, country of the study, comparator, perspective of analysis, source of clinical probabilities, discount rate, time horizon, natural units of effect (cost-effectiveness analysis), utilities (cost-utility analysis), costs, and ICERs.
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