Breast Cancer

, Volume 14, Issue 1, pp 81–87 | Cite as

Economic evaluation of the prevention and treatment of breast cancer-present status and open issues

  • Hirohisa Imai
  • Katsumasa Kuroi
  • Shozo Ohsumi
  • Michikazu Ono
  • Kojiro Shimozuma
Review Article



More effective methods of preventing and treating breast cancer are being sought by clinicians every day, and new drugs and interventions for overcoming this cancer are being energetically evaluated. At present, there are wide treatment options and many different objectives for breast cancer. These circumstances led us to seek information about the relative costs of the different medical options for the prevention and treatment of breast cancer and to try to ascertain whether one course of action is more efficient than other courses. Economic evaluation of healthcare is indispensable for selection of the best alternatives among medical interventions which are becoming more diverse day after day. The total medical expenditure continues to rise each year and some sort of evaluation from an objective and external viewpoint is required to provide the information with which to suppress this rise.


This paper surveys the three major reports published on this topic to date, for the purpose of demonstrating the importance and necessity of performing an economic analysis of the treatment and prevention of breast cancer. The three reports to be surveyed pertain to: (1) cost-effectiveness analysis of adjuvant chemotherapy for patients with lymph node negative breast cancer, (2) cost utility analysis of first-line hormonal therapy in advanced breast cancer, namely comparison of two aromatase inhibitors to tamoxifen, and (3) cost-effectiveness analysis of tamoxifen in the prevention of breast cancer. In addition, this paper discusses the advantages, limitations and perspective for the future of the economic evaluation of healthcare for breast cancer.


(1) The authors concluded that if the average risk of all women of undergoing recurrence after this therapy is assumed to be 4% per year, adjuvant chemotherapy is definitely of benefit for node-negative, estrogen receptor-negative breast cancer patients. They additionally stated that this benefit decreases markedly if the changes in long-term survival are less than those in disease-free survival. In this connection, they pointed out that the benefit is considerably smaller among postmenopausal 60-year-old women. (2) The incremental cost per quality-adjusted progression-free life year (QAPFY) for letrozole and anastrozole, relative to tamoxifen, was Can $12, 500-19, 600, which was lower than the criterion level (US $50, 000). On the basis of this result, the authors concluded that these two drugs are economically acceptable. Furthermore, when efficacy and cost effectiveness were analyzed together, it was concluded that letrozole is in fact preferable to anastrozole. (3) The model analysis of tamoxifen’s cost effectiveness among women at increased risk for breast cancer yielded the following results. In the base-case analysis, involving the calculation of the costs and benefits of 5-year tamoxifen administration, the incremental cost effectiveness of tamoxifen was $41, 372 per life-year gained for women age 35 to 49 years, whereas for women age 50 to 59 years and 60 to 69 years, these values were $68, 349 and $74, 981, respectively. For women who had undergone hysterectomy and thus had no risk of the onset of endometrial cancer, the incremental cost effectiveness of tamoxifen was $46, 060 per life-year gained.


Medico-economic evaluation of breast cancer is very significant and valuable and is expected to stimulate efficient utilization of healthcare resources. It can provide important information to physicians, patients, insurers, pharmaceutical and other industries, healthcare policy planners, and others.

Key words

Breast cancer Economic evaluation Cost-effectiveness analysis Cost-utility analysis 



Quality-adjusted progression-free life year


Quality of life


Cost effectiveness ratio


Quality-adjusted life year


Cyclophosphamide methotrexate fluorouracil


Randomized clinical trial


Breast cancer prevention trial


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  1. 1).
    Brown ML, Lipscomb J, Snyder C: The burden of illness of cancer: Economic cost and quality of life.Annu Rev Public Health 22:91–113, 2001.PubMedCrossRefGoogle Scholar
  2. 2).
    WHO Statistics Information System. WHO Mortality Database. Table 1: Number of registered deaths. Released: January 2005. ( who-sis/mort/tablel.cfm?path=whosis, inds, mort, mort_tablel&language=english)Google Scholar
  3. 3).
    Mina L, Sledge GW Jr: Twenty years of systemic therapy for breast cancer.Oncology (Williston Park) 20:25–32, 2006.PubMedGoogle Scholar
  4. 4).
    Wright T, McGechan A: Breast cancer: new technologies for risk assessment and diagnosis.Molecular Diagnosis 7:49–55, 2003.PubMedCrossRefGoogle Scholar
  5. 5).
    Gold MR, Siegel JE, Russell LB, Weinstein MC edited: Cost-effectiveness in health and medicine. Oxford University Press, New York. 1996.Google Scholar
  6. 6).
    M. F. Drummond, Mark J, Sculpher, George W, Torrance, Bernie J, O’brien, Greg L, Stoddart. edited: Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press. 3rd 2005.Google Scholar
  7. 7).
    Hillner BE, Smith TJ: Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model.N Engl J Med 324:160–168, 1991.PubMedGoogle Scholar
  8. 8).
    Dranitsaris G, Verma S, Trudeau M: Cost utility analysis of first-line hormonal therapy in advanced breast cancer: comparison of two aromatase inhibitors to tamoxifen.Am J Clin Oncol 26:289–296, 2003.PubMedCrossRefGoogle Scholar
  9. 9).
    Noe LL, Becker RV 3rd, Gradishar WJ, Gore M, Trotter JP: The cost effectiveness of tamoxifen in the prevention of breast cancer.Am J Manag Care 5 (6 Suppl): S389–406, 1999.Google Scholar
  10. 10).
    National Cancer Institute. Clinical alert. Bethesda, Md.: National Cnacer Institute, May 16–18, 1988.Google Scholar
  11. 11).
    Ingle JN: Assessing the risk of recurrence in breast cancer.N Engl J Med 322:329–331, 1990.PubMedCrossRefGoogle Scholar
  12. 12).
    Bonneterre J, Thurlimann B, Robertson JF, Krzakowski M, Mauriac L, Koralewski P, Vergote I, Webster A, Steinberg M, von Euler M: Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability study.J Clin Oncol 18:3748–3757, 2000.PubMedGoogle Scholar
  13. 13).
    Mouridsen H, Gershanovich M, Sun Y, Perez-Carrion R, Boni C, Monnier A, Apffelstaedt J, Smith R, Sleeboom HP, Janicke F, Pluzanska A, Dank M, Becquart D, Bapsy PP, Salminen E, Snyder R, Lassus M, Verbeek JA, Staffler B, Chaudri-Ross HA, Dugan M: Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a phase IE study of the International Letrozole Breast Cancer Group.J Clin Oncol May 19:2596–2606, 2001.Google Scholar
  14. 14).
    Wait SH: Economic evaluation of endocrine therapy in the treatment of breast cancer.Anticancer Drugs 9:849–857, 1998.PubMedCrossRefGoogle Scholar
  15. 15).
    Butler JR: The economic potential of tamoxifen prophylaxis in breast cancer.Pharmacoeconomics 12:303–306, 1997.PubMedCrossRefGoogle Scholar
  16. 16).
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.J Natl Cancer Inst 90:1371–1388, 1998.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2007

Authors and Affiliations

  • Hirohisa Imai
    • 1
  • Katsumasa Kuroi
    • 2
  • Shozo Ohsumi
    • 3
  • Michikazu Ono
    • 4
  • Kojiro Shimozuma
    • 5
  1. 1.Department of EpidemiologyNational Institute of Public HealthWako-shi, Saitama-kenJapan
  2. 2.Division of Surgery, Breast OncologyNyuwakai Oikawa HospitalJapan
  3. 3.Department of Breast OncologyNational Hospital Organization Shikoku Cancer CenterJapan
  4. 4.Department of Health Science and Social WelfareSchool of Human Sciences Waseda UniversityJapan
  5. 5.Department of Healthcare and Social Services, Faculty of Service IndustriesUniversity of Marketing and Distribution SciencesJapan

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