Breast Cancer Research and Treatment

, Volume 115, Issue 2, pp 221–222 | Cite as

Cost-effective analyses in Breast Cancer Research and Treatment

  • Marc E. Lippman
  • Stephen Ethier
  • Daniel F. Hayes

Since its inception, Breast Cancer Research and Treatment (BCRT) has been a publication source for manuscripts that describe new laboratory, clinical, or epidemiologic data regarding breast cancer. In addition, the Editors have encouraged thoughtful state-of-the-art reviews and commentaries. During this time, the field has witnessed remarkable progress in our understanding of the genetics and molecular biology that drive the breast cancer phenotype and in the evaluation and treatment of patients with this disease. Indeed, these successes have led to a plethora of new diagnostic and treatment strategies that have been accompanied by a dramatic decline in breast cancer mortality in the Western world over the last 30 years [1, 2].

However, these new advances are not without cost. Concomitant with progress has come a concern over the financial implications of supplying these new treatments to patients. This concern has led to an entirely new field of research: analysis of cost effectiveness in medicine in general and oncology specifically [3]. BCRT has, like many journals with clinical content, included manuscripts in which the cost effectiveness of a new treatment has been compared to an existing one [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. Recently, though, the Editors have noticed a disturbing trend in that the submitted manuscripts appear to have been mainly or totally prepared and written by pharmaceutical companies. In these manuscripts, a new therapeutic agent produced by the sponsor is usually compared to other treatments and, not surprisingly, usually with favorable results.

After careful deliberation, the Editors have decided that although we remain interested in scholarly cost-effectiveness studies, the rigor of review of such manuscripts will be elevated. In the future, any such study will require a documented statement that either the study was not supported by a pharmaceutical company or if so, that the sponsor had no input into design or analysis of the cost-effective analysis, nor did they have final review. Rather, each author will be asked to document his or her role in the study, and in the future potential authors are encouraged to decline if they feel that their role is insufficient to merit their inclusion. The Editors of BCRT are not alone in our concern regarding apparent or real pharmaceutical influence over manuscript preparation. Recently, editors of The Oncologist® expressed similar apprehension, concluding that they will “accept papers for review only if the article was written, endorsed, and proffered for publication by the authors identified in the byline” [19].

We hope that this new policy will enhance the quality of the journal without inhibiting submission of well-designed, and unbiased, manuscripts.


  1. 1.
    Peto R, Boreham J, Clarke M, Davies C, Beral V (2000) UK and USA breast cancer deaths down 25% in year 2000 at ages 20–69 years. Lancet 355:1822CrossRefPubMedGoogle Scholar
  2. 2.
    Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353:1784–1792CrossRefPubMedGoogle Scholar
  3. 3.
    Shih YC, Halpern MT (2008) Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean? CA Cancer J Clin 58:231–244PubMedGoogle Scholar
  4. 4.
    Au HJ, Golmohammadi K, Younis T, Verma S, Chia S, Fassbender K, Jacobs P (2009) Cost-effectiveness analysis of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) for node-positive breast cancer: modeling the downstream effects. Breast Cancer Res Treat 114:579–587CrossRefPubMedGoogle Scholar
  5. 5.
    Delea TE, El-Ouagari K, Karnon J, Sofrygin O (2008) 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 108:375–387CrossRefPubMedGoogle Scholar
  6. 6.
    El Ouagari K, Karnon J, Delea T, Talbot W, Brandman J (2007) Cost-effectiveness of letrozole in the extended adjuvant treatment of women with early breast cancer. Breast Cancer Res Treat 101:37–49CrossRefPubMedGoogle Scholar
  7. 7.
    Fountzilas G, Dafni U, Dimopoulos MA, Koutras A, Skarlos D, Papakostas P, Gogas H, Bafaloukos D, Kalogera-Fountzila A, Samantas E, Briasoulis E, Pectasides D, Maniadakis N, Matsiakou F, Aravantinos G, Papadimitriou C, Karina M, Christodoulou C, Kosmidis P, Kalofonos HP (2009) A randomized phase III study comparing three anthracycline-free taxane-based regimens, as first line chemotherapy, in metastatic breast cancer: A Hellenic Cooperative Oncology Group study. Breast Cancer Res Treat 115(1):87–89Google Scholar
  8. 8.
    Kondo M, Hoshi SL, Ishiguro H, Yoshibayashi H, Toi M (2008) Economic evaluation of 21-gene reverse transcriptase-polymerase chain reaction assay in lymph-node-negative, estrogen-receptor-positive, early-stage breast cancer in Japan. Breast Cancer Res Treat 112:175–187CrossRefPubMedGoogle Scholar
  9. 9.
    Lee SG, Jee YG, Chung HC, Kim SB, Ro J, Im YH, Im SA, Seo JH (2009) Cost-effectiveness analysis of adjuvant therapy for node positive breast cancer in Korea: docetaxel, doxorubicin and cyclophosphamide (TAC) versus fluorouracil, doxorubicin and cyclophosphamide (FAC). Breast Cancer Res Treat 114:589–595CrossRefPubMedGoogle Scholar
  10. 10.
    Locker GY, Mansel R, Cella D, Dobrez D, Sorensen S, Gandhi SK (2007) Cost-effectiveness analysis of anastrozole versus tamoxifen as primary adjuvant therapy for postmenopausal women with early breast cancer: a US healthcare system perspective. The 5-year completed treatment analysis of the ATAC (‘Arimidex’, Tamoxifen Alone or in Combination) trial. Breast Cancer Res Treat 106:229–238CrossRefPubMedGoogle Scholar
  11. 11.
    Lundkvist J, Wilking N, Holmberg S, Jonsson L (2007) Cost-effectiveness of exemestane versus tamoxifen as adjuvant therapy for early-stage breast cancer after 2–3 years treatment with tamoxifen in Sweden. Breast Cancer Res Treat 102:289–299CrossRefPubMedGoogle Scholar
  12. 12.
    Lux MP, Hartmann M, Jackisch C, Raab G, Schneeweiss A, Possinger K, Oyee J, Harbeck N (2009) Cost-utility analysis for advanced breast cancer therapy in Germany: results of the fulvestrant sequencing model. Breast Cancer Res Treat. doi:10.1007/s10549-008-0294-9
  13. 13.
    Malin JL, Keeler E, Wang C, Brook R (2002) Using cost-effectiveness analysis to define a breast cancer benefits package for the uninsured. Breast Cancer Res Treat 74:143–153CrossRefPubMedGoogle Scholar
  14. 14.
    Naeim A, Keeler EB (2005) Is adjuvant therapy for older patients with node (+) early breast cancer cost-effective? Breast Cancer Res Treat 94:95–103CrossRefPubMedGoogle Scholar
  15. 15.
    Shiroiwa T, Fukuda T, Shimozuma K, Ohashi Y, Tsutani K (2008) The model-based cost-effectiveness analysis of 1-year adjuvant trastuzumab treatment: based on 2-year follow-up HERA trial data. Breast Cancer Res Treat 109:559–566CrossRefPubMedGoogle Scholar
  16. 16.
    Shuhendler AJ, Cheung RY, Manias J, Connor A, Rauth AM, Wu XY (2009) A novel doxorubicin-mitomycin C co-encapsulated nanoparticle formulation exhibits anti-cancer synergy in multidrug resistant human breast cancer cells. Breast Cancer Res Treat. doi:10.1007/s10549-008-0271-3
  17. 17.
    Skedgel C, Rayson D, Dewar R, Younis T (2007) Cost-utility of adjuvant hormone therapies for breast cancer in post-menopausal women: sequential tamoxifen-exemestane and upfront anastrozole. Breast Cancer Res Treat 101:325–333CrossRefPubMedGoogle Scholar
  18. 18.
    Younis T, Rayson D, Sellon M, Skedgel C (2008) Adjuvant chemotherapy for breast cancer: a cost-utility analysis of FEC-D vs. FEC 100. Breast Cancer Res Treat 111(26):1–267Google Scholar
  19. 19.
    Chabner BA (2009) Ghost writers in the sky. Oncologist 14:199–200CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • Marc E. Lippman
    • 1
  • Stephen Ethier
    • 2
  • Daniel F. Hayes
    • 3
  1. 1.Department of MedicineUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Breast Cancer ProgramKarmanos Cancer InstituteDetroitUSA
  3. 3.Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA

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