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Published in: PharmacoEconomics 3/2006

01-03-2006 | Review Article

Aromatase Inhibitors in Breast Cancer

A Review of Cost Considerations and Cost Effectiveness

Author: Dr Jonathan Karnon

Published in: PharmacoEconomics | Issue 3/2006

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Abstract

Aromatase inhibitors (AIs) have been evaluated clinically in a wide range of breast cancer treatment settings. Although these agents appear to have clinical superiority, they are more expensive than the therapies (primarily tamoxifen) they have been compared with, thus economic evaluation is required to consider their incremental value to the payer. This paper reviews published economic evaluations of AIs as first-line therapy for advanced cancer, and as adjuvant therapy for early breast cancer.
The evaluations in the advanced setting demonstrate a range of different modelling techniques and consider the payer’s perspective in three healthcare systems. There is broad similarity in the application of standard cohort Markov modelling techniques to evaluate AIs in the early breast cancer setting, covering four separate health system perspectives.
Is appear cost effective compared with current practice. An analysis in the advanced setting suggests that letrozole may be the more cost-effective AI. No direct comparisons of alternative AIs in the adjuvant setting are reported, although indirect comparisons may be feasible. Future evaluations of treatment strategies over the entire course of the disease may also be needed.
Literature
2.
go back to reference Will BP, Berthelot J-M, Le Petit C, et al. Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 2000; 36: 724–735PubMedCrossRef Will BP, Berthelot J-M, Le Petit C, et al. Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer 2000; 36: 724–735PubMedCrossRef
3.
go back to reference Stockler M, Wilcken NRC, Ghersi D, et al. Systematic reviews of chemotherapy and endocrine therapy in metastatic breast cancer. Cancer Treat Rev 2000; 26: 151–168PubMedCrossRef Stockler M, Wilcken NRC, Ghersi D, et al. Systematic reviews of chemotherapy and endocrine therapy in metastatic breast cancer. Cancer Treat Rev 2000; 26: 151–168PubMedCrossRef
4.
go back to reference Haller DG, Fox KR, Schucter LM. Metastatic breast cancer. In: Fowble B, Goodman RL, Glick JH, et al., editors. Breast cancer treatment: a comprehensive guide to management. St Louis (MO): Mosby Year Book, 1991 Haller DG, Fox KR, Schucter LM. Metastatic breast cancer. In: Fowble B, Goodman RL, Glick JH, et al., editors. Breast cancer treatment: a comprehensive guide to management. St Louis (MO): Mosby Year Book, 1991
6.
go back to reference Tamaki Y, Miyoshi Y, Kim SJ, et al. Aromatase inhibitors for treatment of postmenopausal patients with breast cancer. Expert Rev Anticancer Ther 2003; 3: 193–201PubMedCrossRef Tamaki Y, Miyoshi Y, Kim SJ, et al. Aromatase inhibitors for treatment of postmenopausal patients with breast cancer. Expert Rev Anticancer Ther 2003; 3: 193–201PubMedCrossRef
7.
go back to reference Dombernowsky P, Smith I, Falkson G, et al. Letrozole, a new aromatase inhibitor for advanced breast cancer: double blind randomised trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate. J Clin Oncol 1998; 16: 453–461PubMed Dombernowsky P, Smith I, Falkson G, et al. Letrozole, a new aromatase inhibitor for advanced breast cancer: double blind randomised trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate. J Clin Oncol 1998; 16: 453–461PubMed
8.
go back to reference Gershanovich M, Chaudri HA, Campos D, et al. Letrozole, a new aromatase inhibitor: randomised trial comparing 2.5mg daily, 0.5mg daily and aminoglutethamide in postmenopausal women with advanced breast cancer. Ann Oncol 1998; 9: 639–645PubMedCrossRef Gershanovich M, Chaudri HA, Campos D, et al. Letrozole, a new aromatase inhibitor: randomised trial comparing 2.5mg daily, 0.5mg daily and aminoglutethamide in postmenopausal women with advanced breast cancer. Ann Oncol 1998; 9: 639–645PubMedCrossRef
9.
go back to reference Buzdar A, Douma J, Davidson N, et al. Phase III, multicenter, double-blind, randomized study of letrozole, an aromatase inhibitor, for advanced breast cancer versus megestrol acetate. J Clin Oncol 2001; 19: 3357–3366PubMed Buzdar A, Douma J, Davidson N, et al. Phase III, multicenter, double-blind, randomized study of letrozole, an aromatase inhibitor, for advanced breast cancer versus megestrol acetate. J Clin Oncol 2001; 19: 3357–3366PubMed
10.
go back to reference Buzdar AU, Jones SE, Vogel CL, et al. A phase III trial comparing anastrozole (1 and 10 milligrams), a potent and slective aromatase inhibitor, with MA in postmenopausal women with advanced breast carcinoma. Cancer 1997; 79: 730–739PubMedCrossRef Buzdar AU, Jones SE, Vogel CL, et al. A phase III trial comparing anastrozole (1 and 10 milligrams), a potent and slective aromatase inhibitor, with MA in postmenopausal women with advanced breast carcinoma. Cancer 1997; 79: 730–739PubMedCrossRef
11.
go back to reference Kaufmann M, Bajetta E, Dirix LY, et al. Exemestane is superior to megesterol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. J Clin Oncol 2000; 18: 1399–1411PubMed Kaufmann M, Bajetta E, Dirix LY, et al. Exemestane is superior to megesterol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. J Clin Oncol 2000; 18: 1399–1411PubMed
12.
go back to reference Mouridsen H, Gershanovich M, Sun Y, et al. Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a phase III study of the International Letrozole Breast Cancer Group [published erratum appears in J Clin Oncol 2001; 19: 3302]. J Clin Oncol 2001; 19: 2596–2606PubMed Mouridsen H, Gershanovich M, Sun Y, et al. Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a phase III study of the International Letrozole Breast Cancer Group [published erratum appears in J Clin Oncol 2001; 19: 3302]. J Clin Oncol 2001; 19: 2596–2606PubMed
13.
go back to reference Nabholtz JM, Buzdar A, Pollak M, et al. Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group. J Clin Oncol 2000; 18: 3758–3767PubMed Nabholtz JM, Buzdar A, Pollak M, et al. Anastrozole is superior to tamoxifen as first-line therapy for advanced breast cancer in postmenopausal women: results of a North American multicenter randomized trial. Arimidex Study Group. J Clin Oncol 2000; 18: 3758–3767PubMed
14.
go back to reference Bonneterre J, Thurlimann B, Robertson JF, et al. Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability study. J Clin Oncol 2000; 18: 3748–3757PubMed Bonneterre J, Thurlimann B, Robertson JF, et al. Anastrozole versus tamoxifen as first-line therapy for advanced breast cancer in 668 postmenopausal women: results of the Tamoxifen or Arimidex Randomized Group Efficacy and Tolerability study. J Clin Oncol 2000; 18: 3748–3757PubMed
15.
go back to reference Goss PE, Ingle IN, Martino S, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early stage breast cancer. N Engl J Med 2003; 349 (19): 1793–1802PubMedCrossRef Goss PE, Ingle IN, Martino S, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early stage breast cancer. N Engl J Med 2003; 349 (19): 1793–1802PubMedCrossRef
18.
go back to reference Howell A, Cuzick J, Baum M, et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 2005; 365: 60–62PubMedCrossRef Howell A, Cuzick J, Baum M, et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 2005; 365: 60–62PubMedCrossRef
19.
go back to reference Jakesz R, Kaufmann M, Gnant M, et al. Benefits of switching postmenopausal women with hormone-sensitive early breast cancer to anastrozole after 2 years adjuvant tamoxifen: combined results from 3123 women enrolled in the ABCSG Trial 8 and the ARNO 95 Trial [abstract]. Proceedings of the San Antonio 2003 Breast Cancer Symposium. Breast Cancer Res Treat 2004; 88 Suppl. 1: S7 (2) Jakesz R, Kaufmann M, Gnant M, et al. Benefits of switching postmenopausal women with hormone-sensitive early breast cancer to anastrozole after 2 years adjuvant tamoxifen: combined results from 3123 women enrolled in the ABCSG Trial 8 and the ARNO 95 Trial [abstract]. Proceedings of the San Antonio 2003 Breast Cancer Symposium. Breast Cancer Res Treat 2004; 88 Suppl. 1: S7 (2)
20.
go back to reference Boccardo F, Rubagotti A, Amoroso D, et al. Anastrozole appears to be superior to tamoxifen in women already receiving adjuvant tamoxifen treatment [abstract]. Proceedings of the San Antonio 2002 Breast Cancer Symposium. Breast Cancer Res Treat 2003; 82 Suppl. 1: S6 (3) Boccardo F, Rubagotti A, Amoroso D, et al. Anastrozole appears to be superior to tamoxifen in women already receiving adjuvant tamoxifen treatment [abstract]. Proceedings of the San Antonio 2002 Breast Cancer Symposium. Breast Cancer Res Treat 2003; 82 Suppl. 1: S6 (3)
21.
go back to reference Coombes RC, Hall E, Gibson LJ, et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004; 350: 1081–1092PubMedCrossRef Coombes RC, Hall E, Gibson LJ, et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004; 350: 1081–1092PubMedCrossRef
22.
go back to reference Baum M. Current status of aromatase inhibitors in the management of breast cancer and critique of the NCIC MA-17 trial. Cancer Control 2004; 11 (4): 217–221PubMed Baum M. Current status of aromatase inhibitors in the management of breast cancer and critique of the NCIC MA-17 trial. Cancer Control 2004; 11 (4): 217–221PubMed
24.
go back to reference Goss PE, Ingle IN, Martino S, et al. Updated analysis of the NCIC CfG MA-17 randomized placebo controlled trial of letrozole after five years of tamoxifen in postmenopausal women with early stage breast cancer [abstract]. Proc Am Soc Clin Oncol 2004; 88s: 847 Goss PE, Ingle IN, Martino S, et al. Updated analysis of the NCIC CfG MA-17 randomized placebo controlled trial of letrozole after five years of tamoxifen in postmenopausal women with early stage breast cancer [abstract]. Proc Am Soc Clin Oncol 2004; 88s: 847
25.
go back to reference Karnon J, Jones T. A stochastic economic evaluation of letrozole versus tamoxifen as a first-line hormonal therapy for advanced breast cancer in postmenopausal patients. Pharmacoeconomics 2003; 21 (7): 513–525PubMedCrossRef Karnon J, Jones T. A stochastic economic evaluation of letrozole versus tamoxifen as a first-line hormonal therapy for advanced breast cancer in postmenopausal patients. Pharmacoeconomics 2003; 21 (7): 513–525PubMedCrossRef
26.
go back to reference Karnon J, Johnston SRD, Jones T, et al. A trial-based economic evaluation of letrozole followed by tamoxifen versus tamoxifen followed by letrozole for postmenopausal, advanced breast cancer. Ann Oncol 2003; 14: 1629–1633PubMedCrossRef Karnon J, Johnston SRD, Jones T, et al. A trial-based economic evaluation of letrozole followed by tamoxifen versus tamoxifen followed by letrozole for postmenopausal, advanced breast cancer. Ann Oncol 2003; 14: 1629–1633PubMedCrossRef
27.
go back to reference Delea T, Smith R, Karnon J. Cost-effectiveness of letrozole versus tamoxifen as first-line hormonal therapy for postmenopausal women with advanced breast cancer: the US perspective. Breast Cancer Res Treat 2002; 76 (Suppl. 1): S136 and poster Delea T, Smith R, Karnon J. Cost-effectiveness of letrozole versus tamoxifen as first-line hormonal therapy for postmenopausal women with advanced breast cancer: the US perspective. Breast Cancer Res Treat 2002; 76 (Suppl. 1): S136 and poster
28.
go back to reference Dranitsaris G, Verma S, Trudeau M. Cost utility analysis of first-line hormonal therapy in advanced breast cancer: comparison of two aromatase inhibitors to tamoxifen. Am J Clin Oncol 2003; 26: 289–296PubMed Dranitsaris G, Verma S, Trudeau M. Cost utility analysis of first-line hormonal therapy in advanced breast cancer: comparison of two aromatase inhibitors to tamoxifen. Am J Clin Oncol 2003; 26: 289–296PubMed
29.
go back to reference Nuijten M, Meester L, Waibel F, et al. Cost effectiveness of letrozole in the treatment of advanced breast cancer in postmenopausal women in the UK. Pharmacoeconomics 1999; 16: 379–397PubMedCrossRef Nuijten M, Meester L, Waibel F, et al. Cost effectiveness of letrozole in the treatment of advanced breast cancer in postmenopausal women in the UK. Pharmacoeconomics 1999; 16: 379–397PubMedCrossRef
30.
go back to reference Nuijten M, Fitzimon C, Waild F. Economic evaluation of letrozole in the treatment of advanced breast cancer in postmenopausal women in Canada. Value Health 2000; 3 (1): 31–39PubMedCrossRef Nuijten M, Fitzimon C, Waild F. Economic evaluation of letrozole in the treatment of advanced breast cancer in postmenopausal women in Canada. Value Health 2000; 3 (1): 31–39PubMedCrossRef
31.
go back to reference Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost utility assessments in oncology. J Clin Oncol 2000; 18: 3302–3317PubMed Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost utility assessments in oncology. J Clin Oncol 2000; 18: 3302–3317PubMed
34.
go back to reference Hillner BE. Benefit and projected cost-effectiveness of anastrozole versus tamoxifen as initial adjuvant therapy for patients with early-stage estrogen receptor-positive breast cancer. Cancer 2004; 101 (6): 1311–1322PubMedCrossRef Hillner BE. Benefit and projected cost-effectiveness of anastrozole versus tamoxifen as initial adjuvant therapy for patients with early-stage estrogen receptor-positive breast cancer. Cancer 2004; 101 (6): 1311–1322PubMedCrossRef
35.
go back to reference Locker GY, on behalf of the ATAC Trialists’ Group. Costutility analysis of anastrozole versus tamoxifen as primary adjuvant therapy in postmenopausal women with early breast cancer from a US healthcare system perspective: the 5-year completed treatment analysis of the AT AC (’Arimidex’, Tamoxifen Alone or in Combination) trial. 27th Annual San Antonio Breast Cancer Symposium; 2004 Dec 8–11; San Antonio Locker GY, on behalf of the ATAC Trialists’ Group. Costutility analysis of anastrozole versus tamoxifen as primary adjuvant therapy in postmenopausal women with early breast cancer from a US healthcare system perspective: the 5-year completed treatment analysis of the AT AC (’Arimidex’, Tamoxifen Alone or in Combination) trial. 27th Annual San Antonio Breast Cancer Symposium; 2004 Dec 8–11; San Antonio
36.
go back to reference Mansel R. Cost-utility analysis of anastrozole versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: a UK national health service perspective. 29th ESMO Congress; 2004 Oct 29–Nov 2; Vienna, Austria Mansel R. Cost-utility analysis of anastrozole versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: a UK national health service perspective. 29th ESMO Congress; 2004 Oct 29–Nov 2; Vienna, Austria
37.
go back to reference Brown R, Benedict A, Mansel R. Cost-utility analysis of anastrozole versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: a UK national health service perspective. ISPOR 7th Annual European Congress; 2004 Oct 24–26; Hamburg, Germany Brown R, Benedict A, Mansel R. Cost-utility analysis of anastrozole versus tamoxifen as adjuvant therapy in postmenopausal women with early breast cancer: a UK national health service perspective. ISPOR 7th Annual European Congress; 2004 Oct 24–26; Hamburg, Germany
38.
go back to reference Verma S, Rocchi A, Cheung S. Canadian cost-effectiveness analysis of anastrozole versus tamoxifen in early breast cancer. 26th San Antonio Breast Cancer Symposium; 2003 Dec 3–6; San Antonio (TX) Verma S, Rocchi A, Cheung S. Canadian cost-effectiveness analysis of anastrozole versus tamoxifen in early breast cancer. 26th San Antonio Breast Cancer Symposium; 2003 Dec 3–6; San Antonio (TX)
39.
go back to reference Karnan J, Delea T, Johnston SRD, et al. Cost-effectiveness of letrozole versus tamoxifen as early adjuvant therapy in postmenopausal women with early breast cancer. 7th Milan Breast Cancer Conference; 2005 Jun 15–17; Milan, Italy Karnan J, Delea T, Johnston SRD, et al. Cost-effectiveness of letrozole versus tamoxifen as early adjuvant therapy in postmenopausal women with early breast cancer. 7th Milan Breast Cancer Conference; 2005 Jun 15–17; Milan, Italy
40.
go back to reference Karnan J, Delea TE, Barghout V, et al. Cost-effectiveness analysis of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer in the UK [poster]. ISPOR 8th Annual European Congress; 2005 Nov 6–8; Florence Karnan J, Delea TE, Barghout V, et al. Cost-effectiveness analysis of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer in the UK [poster]. ISPOR 8th Annual European Congress; 2005 Nov 6–8; Florence
41.
go back to reference Delea TE, Karnon J, Thomas SK, et al. Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer from a US perspective [poster]. 28th Annual San Antonio Breast Cancer Symposium; 2005 Dec 8–11; San Antonio Delea TE, Karnon J, Thomas SK, et al. Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in hormone-receptor positive postmenopausal women with early breast cancer from a US perspective [poster]. 28th Annual San Antonio Breast Cancer Symposium; 2005 Dec 8–11; San Antonio
42.
go back to reference Annemans L, Moeremans K, Lamarque H. Health economic assessment of the ATAC trial comparing anastrozole versus tamoxifen in adjuvant treatment of postmenopausal hormone receptor positive early breast cancer [abstract]. ISPOR 7th Annual European Congress; 2004 Oct 24–26; Hamburg Annemans L, Moeremans K, Lamarque H. Health economic assessment of the ATAC trial comparing anastrozole versus tamoxifen in adjuvant treatment of postmenopausal hormone receptor positive early breast cancer [abstract]. ISPOR 7th Annual European Congress; 2004 Oct 24–26; Hamburg
43.
go back to reference Sorensen S, Brown R, Benedict A, et al. Patient-rated utilities in postmenopausal early breast cancer: a cross country comparison. International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 7th Annual European Congress; 2004 Oct 24–26; Hamburg Sorensen S, Brown R, Benedict A, et al. Patient-rated utilities in postmenopausal early breast cancer: a cross country comparison. International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 7th Annual European Congress; 2004 Oct 24–26; Hamburg
44.
go back to reference Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998 May 16; 351 (9114): 1451–1467CrossRef Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998 May 16; 351 (9114): 1451–1467CrossRef
Metadata
Title
Aromatase Inhibitors in Breast Cancer
A Review of Cost Considerations and Cost Effectiveness
Author
Dr Jonathan Karnon
Publication date
01-03-2006
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 3/2006
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200624030-00002

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