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Cost utility analysis of early adjuvant letrozole or anastrozole versus tamoxifen in postmenopausal women with early invasive breast cancer: the UK perspective

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Abstract

Five years with the aromatase inhibitors letrozole or anastrozole is clinically superior to 5 years tamoxifen in postmenopausal women with early breast cancer. This paper analyses the cost-effectiveness of the aromatase inhibitors compared to tamoxifen using the same health economic model. A Markov model describes lifetime incidence of breast cancer events and treatment-related adverse events. Probabilities of disease progression, adverse events, and utility values were estimated using secondary sources; costs of breast-cancer care were obtained from a primary costing study. The incremental cost per QALY gained of letrozole vs. tamoxifen is £10,379 (95% CI £6,705–23,574), and of anastrozole versus tamoxifen is £11,428 (95% CI £6,211–48,795). If a 5-year carry over effect for the reduction in breast cancer events is assumed, the incremental costs per QALY gained compared to tamoxifen are £6,253 (95% CI £3,675–14,766) for letrozole and £7,015 (95% CI £3,316–31,997) for anastrozole. Five years of letrozole or anastrozole therapy is cost-effective in postmenopausal women with early breast cancer. Though the respective confidence intervals show significant overlap, letrozole has a 95% probability of being more cost-effective than tamoxifen at a £20,000 QALY value, whilst anastrozole has an 85% probability.

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Acknowledgments

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. We are particularly grateful for the advice provided by Natalie Papo, Satyin Kaura, and Francois DiTrapani. This research was conducted independently of the BIG 1-98 Steering Committee.

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Authors and Affiliations

  1. School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, S1 4DA, UK

    Jonathan Karnon

  2. Policy Analysis Inc. (PAI), Brookline, MA, USA

    Thomas Delea

  3. Novartis Pharmaceuticals Corp, East Hanover, NJ, USA

    Vicki Barghout

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  1. Jonathan Karnon
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Correspondence to Jonathan Karnon.

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Karnon, J., Delea, T. & Barghout, V. Cost utility analysis of early adjuvant letrozole or anastrozole versus tamoxifen in postmenopausal women with early invasive breast cancer: the UK perspective. Eur J Health Econ 9, 171–183 (2008). https://doi.org/10.1007/s10198-007-0058-1

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