, Volume 9, Issue 1, pp 31-43
Date: 27 Feb 2013

Analisi costo-utilità di anastrozolo versus tamoxifene nel trattamento adiuvante del carcinoma mammario precoce post-menopausale

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Summary

Objectives: To evaluate and compare healthcare-related costs and results on patients’ health state of anastrozole 1mg per os per diem and tamoxifen 20 mg per os per diem for adjuvant treatment in postmenopausal women with early breast cancer.

Methods: On the grounds of the results of an international, multicenter, randomized clinical trial (anastrozole: 3,125 patients; tamoxifen: 3,116 patients), the 68-month disease-free survival (anastrozole: 81.2%; tamoxifen: 78.3%; difference: 2.9%; 95% CI 0.5–4.5%; p<0.05) was considered for an intention-to-treat cost-utility analysis performed following the Italian National Health Service perspective. Healthcare-related costs of drugs, 68-month median follow-up, first events and prespecified adverse events were taken into account. Costs were expressed in Euros 2005. Whenever necessary, costs and effectiveness were discounted at a social rate of 3%.

Results: Patients treated with anastrozole gained 3.784 QALYs instead of 3.670 QALYs with tamoxifen (difference: 0.114 QALYs; 95% CI: 0.109–0.120; p<0.001). Cost for anastrozole patient was € 31,638.15, whereas cost for tamoxifen patient reached € 26,201.48 (difference: € 5,436.67; 95% CI: 5,436.66–5,436.68; p<0.001). The incremental cost-utility ratio amounted to € 47,555.55 (non-parametric bootstrap percentile method 95% CI: 46,091.60–49,683.59). Sensitivity analysis confirmed the robustness of the base case findings.

Conclusions: Anastrozole seems advisable even from an economic point of view, since its incremental cost-utility ratio falls well within the usual acceptability standards for incremental year of life saved (€ 12,000–60,000; US$ 50,000).