Abstract
BackgroundIncreased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer.MethodsIn this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0), and to obtain the utility value by the standard gamble (SG) and visual scale (VS) methods. Total medical cost was assessed from the (National Health Insurance) NHI payer's perspective.ResultsSurvival at 11 years was significantly better in the groserelin group (P < 0.0012). The lifetime lost was lower in the goserelin group (42 months vs. 66 months). The quality adjusted survival (QAS) of patients who received goserelin was longer (122.5 ± 6.3 vs. 112.2 ± 6.7 months). Total expenses of goserelin were more than cyclophosphamide, methotrexate, 5-fluorouracil (CMF) or 5-fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy regimes, but less than docetaxel, epirubicin (TE) or docetaxel, epirubicin, cyclophosphamide (TEC) regimes. The quality-adjusted life-year was higher in the goserelin group.ConclusionsGoserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.
Highlights
Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments
The present study evaluated the costeffectiveness of adjuvant goserelin or adjuvant chemotherapy in stage Ia to IIIa ER + breast cancer patients using health related quality of life (HRQoL) data
QoL and utility values Results of the EORTC-QLQ-C30 questionnaire revealed that patients who received goserelin therapy had a higher standard gamble (SG) utility score than those who received chemotherapy (0.81 ± 0.17 vs. 0.78 ± 0.23) (Table 2)
Summary
Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Endocrine therapy for premenopausal patients with primary breast cancer is based on reducing circulating levels of estrogens. Because the ovary is a major contributor of circulatory estrogen, therapies revolve around reducing ovarian production. Chemotherapy decreases estrogen levels due to cytotoxic effects on the ovaries. Other available therapies to reduce estrogen levels include ovarian ablation by either surgical removal or Luteinizing hormone-releasing hormone (LHRH) analogues provide an alternative therapy. LHRH analogues decrease ovarian estradiol production indirectly by acting on the hypothalamic-pituitary-ovarian axis and inhibiting the secretion of pituitary gonadotrophins [1]. Premenopausal ER + breast cancer patients, additional endocrine therapies are recommended in order to increase the effectiveness of the primary treatment [2]
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