Abstract
Objective Long-term aromatase inhibitor (AI) therapy is expected to improve the health outcomes with high health resource consumption in early breast cancer. The aim of the study was to assess the cost-effectiveness of letrozole for postmenopausal women with estrogen receptor positive early breast cancer in a health resource-limited setting. Methods A Markov model was developed to project the lifetime outcomes based on the clinical course of early breast cancer. The clinical and utility data were derived from reported results. Costs were estimated from the perspective of Chinese health care. The quality-adjusted life-year (QALY) and incremental cost-effective ratio (ICER) were measured. Probabilistic sensitivity and one-way analyses were conducted. Results Compared to 5 years of tamoxifen therapy, 5 years of AI treatment with letrozole improved the QALYs (10.44 versus 10.84) and increased the lifetime costs (CNY ¥13,613 versus CNY ¥28,797), resulting in an ICER of CNY ¥38,092 /QALY. The ICER of 5 years of letrozole versus 2–3 years of tamoxifen and then letrozole was CNY ¥68,233 /QALY. Sensitivity analyses showed that the age of initiating adjuvant endocrine therapy was the most influential parameter. Conclusions In health resource-limited settings, adjuvant endocrine therapy with letrozole is a cost-effective strategy compared to tamoxifen in women with early breast cancer.
Highlights
Breast cancer is the most common cancer in Chinese women
Compared with tamoxifen and the aromatase inhibitor (AI) switch strategy, the AI 5-year strategy had a lower incidence of recurrence of breast cancer and endometrial cancer, more health benefits, and higher costs, which resulted in the incremental cost-effective ratio (ICER) of CNY ¥ 38,092 and 68,233/quality-adjusted life-year (QALY), respectively
Our study indicates that adjuvant endocrine therapy with the AI 5year strategy offers greater health benefits and higher cost compared to the tamoxifen and AI switch strategy
Summary
Breast cancer is the most common cancer in Chinese women. Cases in China account for 12.2% of all newly diagnosed breast cancers and 9.6% of all deaths from breast cancer worldwide [1]. According to the Global Burden of Disease (GBD) 2013, the disability-adjusted life years (DALY) of Chinese breast cancer increased from 1062.6 thousand in 1990 to 1,666.0 thousand in 2013, and the peak age-specific DALY rate was at 50 to 59 years [2]. Because of the lack of funding and concern about false-positive diagnoses of annual mammography, no national screening program for breast cancer was available in China. For women with early-stage breast cancer, the primary treatment goals are recurrence control and improvement in the quality of life [4]
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