Coste-efectividad del tratamiento de síntomas vasomotores en cáncer de mama con desvenlafaxina en México

Abstract

ObjectiveEstimate the cost-effectiveness of vaso-motor symptoms (VMS) management with hormone replacement therapy (HRT) and non-hormonal alternatives in patients with breast cancer (BC), regarding the Mexican institutional perspective.MethodsA Markov model was developed to estimate health and economic consequences until five years (quarterly cycles). Effectiveness measures were: reduction in hot flashes and quality-adjusted life years gained (QALY’s). Alternatives compared were: conjugated estrogens + medroxyprogesterone (2.5 mg/0.625 mg/day), tibolone (2.5 mg/day), conjugated estrogens (CE, 0.625 mg/day) and no treatment. Desvenlafaxine (100 mg/day) was the non-hormonal reference. The effectiveness of the therapies was extracted from published literature. The resource use profile was obtained from retrospective review of clinical files (n=140) of patients attending Instituto Mexicano del Seguro Social. Costs were extracted from official sources. Acceptability curves were constructed.ResultsIn patients with no contraindication to HRT, desvenlafaxine had the lowest cost (between US$3.011,46 and US$3.169,29) and higher levels of effectiveness and utility (at least 441 fewer hot flashes and 0.16 QALY’s more than CE). In patients with HRT contraindicated, desvenlafaxine is more expensive than no treatment (US$1.186), but prevented 2.754 hot flashes and gained 0.75 QALY’s. Acceptability curves show that desvenlafaxine is the non-hormonal therapy most likely to be cost effective.ConclusionsDesvenlafaxine is a cost-saving and cost effective non-hormonal alternative in the management of VMS in both, BC patients without and with contraindication to HRT use, respectively.