Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early breast cancer in Brazil

Marcelo Fonseca,Gabriela T B Araújo,Everardo D Saad

doi:10.1590/s0104-42302009000400015

Abstract

Breast cancer, a leading type of cancer in many developing countries, is the most frequent non-cutaneous tumor in Brazil. Hormone therapy is the standard of care in the adjuvant treatment of early-stage, hormone-receptor-positive disease, and both tamoxifen and third-generation aromatase inhibitors are options in postmenopausal women. The comparative cost-effectiveness of different treatment strategies is of considerable interest in societies facing limited resources. In an attempt to compare cost-effectiveness of upfront treatment with tamoxifen or anastrozole, the medical and economic results in a hypothetical cohort of 64-year-old postmenopausal women, was analyzed considering the Brazilian healthcare system in 2005, the primary perspective of the private sector, and a lifetime horizon. Data from the ATAC Trial, Markov modeling, a modified Delphi panel, and microcosting (in Brazilian R$) were used to estimate costs and effectiveness of the two upfront strategies. The model estimated a gain of 0.55 discounted life-years for patients receiving anastrozole, relative to those treated with tamoxifen. With an incremental cost of R$ 15,141.15, the model estimated that the cost-effectiveness of anastrozole, in relation to tamoxifen, was R$ 27,326.80. Monte Carlo simulations showed that approximately 50% of the cases fell below the threshold of R$ 29,229.00 per life-year gained, which is recommended by the World Health Organization for Brazil. It was concluded that upfront anastrozole is a cost-effective option compared with tamoxifen in the adjuvant treatment of postmenopausal women with hormone-receptor-positive early breast cancer.

Highlights

Breast cancer is the most frequent non-cutaneous tumor type in Brazil, where it accounts for approximately 50,000 new cases each year[1]
Effectiveness Considering a lifetime horizon, the adjuvant treatment with tamoxifen resulted in 14.39 discounted life-years gained
There was an additional gain of 0.55 discounted life-years, resulting in 14.94 discounted life-years gained

Summary

Introduction

Breast cancer is the most frequent non-cutaneous tumor type in Brazil, where it accounts for approximately 50,000 new cases each year[1]. It is a leading type of cancer in many other developing countries, and is considered a public health problem[2]. Breast tumors express hormone receptors in approximately 75% of the patients diagnosed after menopause[5,6]. Hormone therapy is considered a standard of care in the adjuvant treatment of early-stage disease in such cases. The antiestrogen tamoxifen has been considered the standard hormone therapy in adjuvant treatment of postmenopausal women with early breast cancer[8]. Third-generation aromatase inhibitors, including anastrozole, exemestane and letrozole, have improved the disease-free survival rates, in comparison with a 5 year treatment with tamoxifen[9]

Methods

Results

Discussion

Conclusion