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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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Abstract

Background

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.

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Acknowledgements

Financial Support: This study was funded by Novartis Pharmaceuticals Corporation.

Potential Conflicts of Interest: TD and OS are employees of PAI, an independent contract research organization, which has received research support and consulting fees from Novartis and other pharmaceutical companies. JK has received research support from Novartis. K E-O is an employee of Novartis.

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Authors and Affiliations

  1. Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

    Thomas E. Delea & Oleg Sofrygin

  2. Novartis Pharmaceuticals Corp., Dorval, Quebec, Canada

    Khalid El-Ouagari

  3. School of Health and Related Research, University of Sheffield, Sheffield, UK

    Jonathan Karnon

Authors
  1. Thomas E. Delea
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  2. Khalid El-Ouagari
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  3. Jonathan Karnon
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  4. Oleg Sofrygin
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Correspondence to Thomas E. Delea.

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This research was conducted independently of the BIG 1-98 Steering Committee.

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Delea, T.E., El-Ouagari, K., Karnon, J. et al. Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in postmenopausal women with hormone-receptor positive early breast cancer from a Canadian perspective. Breast Cancer Res Treat 108, 375–387 (2008). https://doi.org/10.1007/s10549-007-9607-7

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