RESUMEN
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Asunto(s)
Humanos , Diabetes Mellitus/economía , Diabetes Mellitus/epidemiología , Costo de Enfermedad , Costos de la Atención en Salud , Bases de Datos Bibliográficas , España/epidemiologíaRESUMEN
Objective. To compare the efficiency of adjuvanttherapy with aromatase inhibitors or with tamoxifenin postmenopausal women with operablebreast cancer and positive estrogen receptors.Material and methods. A cost-utility analysis wasperformed based on a Markov model, from theSpanish National Health Care System perspective,comparing the treatment with exemestane (EXE: 25mg/day) or tamoxifen (TAM: 20 mg/day) after 2-3years of monotherapy with TAM; anastrozole (ANA,1 mg/day) or TAM (20 mg/day) without previousTAM therapy; and letrozole (LET: 2.5 mg/day) orplacebo after 5 years of monotherapy with TAM.The follow-up of a hypothetical cohort of womenstarting treatment at 63 years of age was simulatedduring 10 and 20 years. The probabilities of transitionbetween health states and quality adjusted lifeyears (QALYs) were obtained from the literature,and the unit costs ( corresponding to 2004) from aSpanish database.Results. After 10 and 20 years of follow-up, moreQALYs per patient would be gained with the EXEscheme (0.230-0.286 and 0.566-0.708, respectively)than with ANA (0.114 and 0.285) and LET (0.176and 0.474). The cost of gaining one QALY was lowerwith the EXE scheme (50,801-62,522 and 28,849-35,371 , respectively) than with ANA (104,272 and 62,477 ) and LET (91,210 and 49,460 ). Theresult was stable for the cost per life-year gained(LYG) and in the sensitivity analysis.Conclusions. The EXE scheme after TAM is morecost-effective than the ANA and LET schemes
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