Cost-effectiveness analysis of extended adjuvant endocrine therapy in the treatment of post-menopausal women with hormone receptor positive breast cancer.

Five years of Tamoxifen (Standard TAM) is a common treatment option for early-stage, hormone receptor positive (HR+) breast cancer (BC). Extending Standard TAM by 5 additional years (Extended TAM) can improve survival and BC recurrences. In postmenopausal women, the use of extended aromatase inhibitors (Extended AI) after Standard TAM is an alternative to Extended TAM. This study examines the cost-effectiveness (CE) of extending Standard TAM with Extended TAM vs. Extended AI in postmenopausal HR+ early-stage BC patients. Three treatments were assessed: (1) Standard TAM; (2) Extended TAM; (3) Extended AI through a Markov model using a Canadian health system perspective, lifetime time-horizon, quality adjusted life years (QALYs), and a 5 % discount rate for future costs and utilities. Incremental cost-effectiveness ratios (ICERs) were calculated, and the impact of parameter uncertainty was assessed through probabilistic sensitivity analyses (SA) using conventional CE thresholds. The estimated total per person costs in 2012 Canadian dollars [$1.00 CAD = $0.99 US 2012] were the least for Extended TAM ($8,623 CAD) and most for Extended AI ($9,432 CAD). Extended AI was the most effective regimen, while Standard TAM was the least. Extended AI was cost-effective at conventional thresholds vs. Extended TAM (ICER: $3,402 CAD/QALY) which was robust to the SA. This study suggests that Extended AI and Extended TAM result in improved QALYs and lower healthcare costs vs Standard TAM. Extended AI results in the greatest improvement in QALYs and is the most cost-effective treatment alternative despite its higher drug costs.

[Assessment of annual health insurance reimbursement for oncology drugs in Hungary]. / Az onkológiai gyógyszerekre fordított éves egészségbiztosítási kiadások meghatározása Magyarországon.

The aim of our study is to analyse the health insurance reimbursement of oncology drugs in outpatient care, inpatient care and named patient system. Data were derived from the database of the National Health Insurance Fund Administration (OEP). The analysis covers data of pharmaceuticals with health insurance reimbursement between 1 January and 31 December, 2008. We performed the analysis according to the ATC group "L" and ICD codes C00-C99 and D00-D48. Within "L" ATC group, for ICD codes C00-C99 and D00-D48 the annual health insurance expenditure for outpatient and named patient drugs were 36.3 billion Hungarian Forints (HUF) (144.5 million EUR, 211.3 million USD). For drugs used in the acute inpatient care, we found 22.59 billion HUF (89.9 million EUR, 131.5 million USD) annual health insurance expenditure. The Hungarian National Health Insurance Fund Administration (OEP) spent altogether 58.9 billion HUF (234.4 million EUR, 342.8 million USD) for the reimbursement of oncological drugs in outpatient, named patient and inpatient care. The reimbursement of oncological drugs represents a significant expenditure for the Hungarian National Health Insurance Fund Administration (OEP). Boncz I, Donka-Verebes É, Oberfrank F, Kásler M. Assessment of annual health insurance reimbursement of oncology drugs in Hungary.

Aromatase inhibitors in early hormone receptor-positive breast cancer : what is the optimal initiation time for the maximum benefit?

Breast cancer is common, affecting one in nine women worldwide. As stipulated by the St Gallen consensus guidelines, hormone therapy is an integral part of treatment for hormone-responsive disease. Previously, this has been with tamoxifen; however, as a result of a number of recent studies, aromatase inhibitors are now competing for use as first-line agents. In addition, there is as yet no firm consensus as to when and how these drugs should be used within the adjuvant setting. This article reviews the use of aromatase inhibitors in early stage hormone-positive breast cancer. It describes the evidence from the studies involving the aromatase inhibitors in an upfront, switch and extended setting. It further discusses the mathematical models proposed to determine the optimum timing of initiation. In light of the ongoing research into predictive biomarkers, this review then concentrates on whether future focus should be on more individualized treatment strategies than the optimum timing of aromatase inhibitors.

Cost-effectiveness of letrozole versus tamoxifen as first-line hormonal therapy in treating postmenopausal women with advanced breast cancer in Japan.

The objective of this study is to evaluate the cost-effectiveness of letrozole compared with tamoxifen as first-line therapy in post-menopausal women with advanced breast cancer in Japan. A Markov analytical model was developed to estimate life-year (LY) expectancies, using key transition probabilities obtained from the results of a multinational phase III trial, a literature review and a Japanese medical expert panel. Direct medical costs were estimated, from the payer's perspective, using the expected resource utilization provided by the expert panel, the medical fee table and drug tariff under the national health insurance system. The expected overall life-years (LYs) obtained were 3.68 years for letrozole arm and 3.09 years for tamoxifen arm, showing incremental LYs of 0.59 years in patients receiving letrozole. The total expected costs were 3,644,588 yen (33,133 US dollars) for letrozole arm and 3,322,111 yen (30,201 US dollars) for tamoxifen arm, resulting in a mean incremental cost-effectiveness ratio (ICER) of 546,571 yen (4,969 US dollars) per life-year gained, while the 5 th percentile of ICER showed letrozole dominating tamoxifen and the 95th percentile was 2,310,593 yen (21,005 US dollars). The results suggest that letrozole is a clinically beneficial and cost-effective treatment option when compared with tamoxifen in first-line therapy for advanced breast cancer in Japan.

Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis.

BACKGROUND: We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives. PATIENTS AND METHODS: 65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed. RESULTS: The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion. CONCLUSION: Orchiectomy is the treatment of choice when life expectancy is more than two years.