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Annals of Oncology Advance Access published online on November 2, 2005
Annals of Oncology, doi:10.1093/annonc/mdj048
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© 2005 European Society for Medical Oncology
Received June 14, 2005
Revised August 10, 2005
Accepted September 19, 2005

original article

Comparing cost/utility of giving an aromatase inhibitor as monotherapy for 5 years versus sequential administration following 2-3 or 5 years of tamoxifen as adjuvant treatment for postmenopausal breast cancer

P. E. Lønning 1*

1 Section of Oncology, Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway

* To whom correspondence should be addressed.
P. E. Lønning, E-mail: per.lonning{at}helse-bergen.no


  Abstract

Background: Several studies have shown aromatase inhibitors administered as monotherapy or sequentially to tamoxifen to improve relapse-free survival in postmenopausal women with early breast cancer. Any difference in cost/utility between the strategies may be of importance to therapy selection.

Methods: Cost/utility was compared between the different regimens based on the theoretical assumption that costs, benefits and side-effects were similar for each drug and independent of whether it was administered as monotherapy or sequentially.

Results: Tamoxifen for 2-3 years followed by an aromatase inhibitor for 3 or 2 years provided the lowest cost/quality-adjusted life years (QALY) estimates, while administration of an aromatase inhibitor subsequent to 5 years on tamoxifen provided the highest values. The difference between strategies increased with patient age. Cost/QALY estimates were sensitive to an increase in hip fracture risk and to cost reductions due to relapse prevention. Adding oral bisphosphonates increased costs moderately.

Conclusions: While tamoxifen for 2-3 years followed by an aromatase inhibitor provided the lowest cost/QALY estimates, a further improvement of relapse-free survival of 1% if the aromatase inhibitor is given upfront provides an acceptable cost/QALY. In contrast, additional benefits achieved by administering an aromatase inhibitor subsequent to 5 years of tamoxifen provided unacceptable costs.

Keywords: adjuvant therapy; aromatase inhibition; breast cancer; costs; utility.
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