J Breast Cancer.  2010 Sep;13(3):286-298.

Cost-Effectiveness Analysis of Adjuvant Hormonal Treatments for Women with Postmenopausal Hormone-Receptor Positive Early Breast Cancer in the Korean Context

• Lee HJ
• Lee TJ
• Yang BM
• Min J

Abstract

PURPOSE
This study aims to evaluate the cost-effectiveness of two aromatase inhibitors for the adjuvant treatment of women with postmenopausal hormone receptor positive early breast cancer, and to find the most reasonable treatment option when the population is stratified by the nodal status.
METHODS
A Markov model was developed with defining six Markov states based on breast cancer progression. The annual probabilities of recurrence by adjuvant treatment (anastrozole, letrozole, and tamoxifen) were estimated from the published studies in the overall population and in the node negative and node positive groups. The costs of the defined breast cancer events were measured by the micro-costing method based on the 2009 National Health Insurance Fee Schedule and the third Clinical Guideline of Breast Cancer Treatment. Anastrozole and letrozole were compared with tamoxifen respectively, using the same Markov model. The incremental cost-effectiveness ratios for the overall population and each subgroup were estimated.
RESULTS
Anastrozole was more effective and costly than tamoxifen with anastrozole costing an additional Korean Won (KRW) 22,461,689 per quality-adjusted life year (QALY). Letrozole showed a similar incremental cost of KRW 21,004,142 per QALY. In the node negative group, anastrozole was the most cost-effective with an incremental cost of KRW 19,717,770 per QALY, while letrozole was the most cost-effective with an incremental cost of KRW 8,150,512 per QALY for the node positive group. The sensitivity analysis showed that these results were robust.
CONCLUSION
The subgroup analysis clearly demonstrated which treatment was superior among the aromatase inhibitors in terms of the cost-effectiveness. Such a finding was not confirmed for the case of the overall population. The implication of this study is that the decision makers should be careful when generalizing the cost-effectiveness results. The stratified analysis in this context may help reach a reasonable decision for allocating medical resources.

Keyword

Anastrozole; Cost-benefit analysis; Costs and cost analysis; Letrozole

MeSH Terms

Aromatase Inhibitors
Breast
Breast Neoplasms
Cost-Benefit Analysis
Costs and Cost Analysis
Fee Schedules
Female
Humans
National Health Programs
Nitriles
Quality-Adjusted Life Years
Recurrence
Tamoxifen
Triazoles
Aromatase Inhibitors
Nitriles
Tamoxifen
Triazoles

Figure

• 

  Figure 1 Schematic diagram of Markov model. Each bubble represents a health state regarding breast cancer and the direction of arrows means possible transition between states. "Disease free with adverse events" state includes separate states for all possible combinations of adberse events.

• 

  Figure 2 Deterministic sensitivity analysis on cost-effectiveness of anastrozole or letrozole vs. tamoxifen. Bars represent range of cost-effectiveness over range of parameter values examined. Costs are 2009 Korean wons, costs and quality-adjusted life year (QALY) are discounted at 5%. Tam.=tamoxifen vs. no endocrine therapy; Ana.=anastrozle vs. tamoxifen; Let.=letrozole vs. tamoxifen.

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