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A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer

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Abstract

Breast cancer is a global health concern. In fact, breast cancer is the primary cause of death among women worldwide and constitutes the most expensive malignancy to treat. As health care resources are finite, decisions regarding the adoption and coverage of breast cancer treatments are increasingly being based on “value for money,” i.e., cost-effectiveness. As the evidence about the cost-effectiveness of breast cancer treatments is abundant, therefore difficult to navigate, systematic reviews of published systematic reviews offer the advantage of bringing together the results of separate systematic reviews in a single report. As a consequence, this paper presents an overview of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer to inform policy and reimbursement decision-making. A systematic review was conducted of published systematic reviews documenting cost-effectiveness analyses of breast cancer treatments from 2000 to 2014. Systematic reviews identified through a literature search of health and economic databases were independently assessed against inclusion and exclusion criteria. Systematic reviews of original evaluations were included only if they targeted breast cancer patients and specific breast cancer treatments (hormone therapy, chemotherapy, and targeted therapy only), documented incremental cost-effectiveness ratios, and were reported in the English language. The search strategy used a combination of these key words: “breast cancer,” “systematic review/meta-analysis,” and “cost-effectiveness/economics.” Data were extracted using predefined extraction forms and qualitatively appraised using the assessment of multiple systematic reviews (AMSTAR) tool. The literature search resulted in 511 bibliographic records, of which ten met our inclusion criteria. Five reviews were conducted in the early-stage breast cancer setting and five reviews in the metastatic setting. In early-stage breast cancer, evidence about trastuzumab value differed by age. Trastuzumab was cost-effective only in women with HER2-positive breast cancer younger than 65 years and over a life-time horizon. The cost-effectiveness of trastuzumab in HER2-positive metastatic breast cancer yielded conflicting results. The same conclusions were reached in comparisons between vinorelbine and taxanes. In both early stage and advanced/metastatic breast cancer, newer aromatase inhibitors (AIs) have proved cost-effective compared to older treatments. This overview of systematic reviews shows that there is heterogeneity in the evidence concerning the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer. The cost-effectiveness of these treatments depends not only on the comparators but the context, i.e., adjuvant or metastatic setting, subtype of patient population, and perspective adopted. Decisions involving the cost-effectiveness of breast cancer treatments could be made easier and more transparent by better harmonizing the reporting of economic evaluations assessing the value of these treatments.

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Acknowledgments

The authors are grateful to Julian Renaine, data research librarian at Florida State University, for his help in accessing some databases as part of our literature search. Janet P. Barber, Ph.D., helped edit the final version of the paper.

Conflict of interest

The authors have no conflicts of interest to declare.

Author information

Author notes

    Authors and Affiliations

    1. Division of Economic, Social and Administrative Pharmacy College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA

      Vakaramoko Diaby

    2. Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, USA

      Rima Tawk

    3. Unité de Formation et de Recherche (UFR) Sciences Economiques et Développement, Université Alassane Ouattara, Bouaké, Côte d’Ivoire

      Vassiki Sanogo

    4. Center for Economic Forecasting and Analysis (CEFA), Florida State University (FSU), Tallahassee, FL, USA

      Vassiki Sanogo

    5. College of Pharmacy, University of Florida, Gainesville, FL, USA

      Hong Xiao

    6. Taussig Cancer Center Department of Solid Tumor Oncology, Cleveland, OH, USA

      Alberto J. Montero

    Authors
    1. Vakaramoko Diaby
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    2. Rima Tawk
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    3. Vassiki Sanogo
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    4. Hong Xiao
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    5. Alberto J. Montero
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    Corresponding author

    Correspondence to Vakaramoko Diaby.

    Additional information

    Rima Tawk and Vassiki Sanogo have contributed equally to this work.

    Appendix

    Appendix

    Search strategies for databases included in the review

    See Tables 8, 9, 10, 11, 12, 13, 14.

    Table 8 Search in Ovid Medline (Searched on January 17th, 2015)
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    Table 9 Search in OVID Embase
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    Table 10 Search in Pubmed (Searched on January 17th, 2015)
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    Table 11 Search in ISI’s Web of Knowledge
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    Table 12 Search in Cochrane Database of Systematic Reviews (Searched on January 17th, 2015)
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    Table 13 Search in Center for Reviews and Dissemination (CRD) database (Searched on January 19th, 2015)
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    Table 14 Search in EconLit—(Searched on January 19th, 2015)
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    Diaby, V., Tawk, R., Sanogo, V. et al. A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer. Breast Cancer Res Treat 151, 27–40 (2015). https://doi.org/10.1007/s10549-015-3383-6

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    • DOI: https://doi.org/10.1007/s10549-015-3383-6

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