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Tamoxifen Plus Chemotherapy versus Tamoxifen Alone as Adjuvant Therapies for Node-Positive Postmenopausal Women with Early Breast Cancer

A Stochastic Economic Evaluation

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Abstract

Background: There remains uncertainty around the appropriate choice of adjuvant therapies to offer postmenopausal women with node-positive early breast cancer.

Objective and study design: To present the results derived from a discrete event simulation (DES)model that compared tamoxifen plus chemotherapy versus tamoxifen alone in node-positive postmenopausal women diagnosed with early breast cancer.

Methods: The data populating the model were mainly derived from the existing literature, which was analysed to specify probability distributions describing the uncertainty around the true value of each input parameter. The specified probability distributions facilitated the stochastic analysis of the decision model, whereby distributions of the model’s outputs [aggregate costs and quality-adjusted life years (QALYs)] were estimated.

Results: The baseline results show that the addition of chemotherapy to tamoxifen in this patient group is relatively cost effective (under £4000 per additional QALY), but the distribution of the incremental cost-effectiveness ratio shows a wide range, including 10% of observations in which tamoxifen dominates tamoxifen plus chemotherapy.

Conclusions: The results demonstrate the intuitive nature of stochastic evaluations of healthcare technologies, which may ease decision-makers’ interpretation of cost-effectiveness results.

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Acknowledgements

Dr Karnon was funded by the Medical Research Council and a North Thames Training Fellowship grant. The authors are grateful to Andy Briggs for his explanation of Bayesian theory, Liz Fenwick for her advice on stochastic analysis, and Martin Buxton for comments on earlier work relating to this paper.

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  1. Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK

    Jonathan Karnon & Jackie Brown

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Karnon, J., Brown, J. Tamoxifen Plus Chemotherapy versus Tamoxifen Alone as Adjuvant Therapies for Node-Positive Postmenopausal Women with Early Breast Cancer. Pharmacoeconomics 20, 119–137 (2002). https://doi.org/10.2165/00019053-200220020-00005

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