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[A cost-effectiveness study of first-line hormone therapy in post-menopausal patients with metastatic breast cancer
A Ballester Viéitez1, F Ferriols Lisart, J Magraner Gil
1Servicio de Farmacia, Hospital Clínico Universitario, Valencia, Spain. ana.ballester.vieitez@sergas.es
Objective:
Breast cancer is a hormone-dependent tumor, which expands therapy options. The aim of this study was to perform a pharmacoeconomic assessment of these drugs in post-menopausal patients with metastatic breast cancer or on neoadjuvant therapy.
Method:
To assess the efficacy of both drug classes a meta-analysis was carried out from papers obtained in a Medline literature search (1997 - June 2004) using the following keywords: breast cancer, postmenopausal, aromatase inhibitors, antiestrogens, tamoxifen, neoadjuvant. Effectiveness parameters included: objective response, percentage with conservative surgery in neoadjuvancy; in metastatic breast cancer, time to progression. Costs were considered from drug acquisition data. To determine result strength a sensitivity analysis was undertaken, with modified costs and effectiveness.
Results:
Results show a higher effectiveness for aromatase inhibitors as compared to antiestrogens. In neoadjuvant therapy: 56.38% versus 36% for objective response rate, and 47.64% versus 35% for conservative surgery. In metastatic cancer: 9.96 versus 6.61 months for time to progression (p
Conclusions:
Selecting an aromatase inhibitor is a valid option in neoadjuvancy, even if such selection would represent a very high cost for metastatic cancer.