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Cited by 38Health Systems, Economic Evaluations, Quality of LifeBreast Cancer Treatment StudiesBone health and treatments

Cost-utility analysis of second-line hormonal therapy in advanced breast cancer: a comparison of two aromatase inhibitors to megestrol acetate

Dranitsaris, George, Leung, Pauline, Mather, Jennifer, Oza, Amit·2000·Anti-Cancer Drugs
DOI 10.1097/00001813-200008000-00012
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Abstract

Randomized trials comparing the aromatase inhibitors, anastrozole and letrozole, to megestrol acetate (MA) in postmenopausal women with advanced breast cancer demonstrated that both agents are better tolerated than MA with comparable efficacy. In addition, one trial revealed that tumor response and time to treatment failure were significantly better with letrozole. Since oncologists are faced with a choice between three agents with at least comparable efficacy but different toxicity profiles and cost, a cost-utility analysis was conducted to quantify these differences and to determine if the new agents are more cost-effective than MA. In the absence of a randomized three-arm trial, a decision model was developed to simulate the most common therapeutic outcomes. The clinical data were obtained from an overview analysis of randomized trials. Total hospital resource consumption was collected from 87 patients with advanced disease that had failed second-line hormonal therapy. Utility estimates were obtained from interviewing a random sample of 25 women from the general public and 25 female health care professionals using the Time Trade-Off technique. The model suggested a similar duration of quality-adjusted progression-free survival between drugs (letrozole 150 days, anastrozole 153 days and MA 146 days). Letrozole had an overall cost of Can$2949 per patient which was comparable to MA at Can$2966 per patient. In contrast, anastrozole was slightly more costly than MA at $Can3149 per patient, respectively. The analysis revealed that letrozole has comparable overall costs relative to MA while providing at least equivalent quality-adjusted progression-free survival. These outcomes were largely related to its higher tumor response rate, which translated to a lower proportion of patients requiring chemotherapy. Anastrozole was slightly more costly than MA and did not demonstrate superiority in quality-adjusted progression-free survival in this palliative setting.

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Crossref · 10.1097/00001813-200008000-00012

Cites

27 of 27 references verified0 citation errors · 0 not checkable

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  • Anastrozole and letrozole are selective aromatase inhibitors; they are reversible and highly potent.

    “Anastrozole and letrozole are selective aromatase inhibitors.They are reversible and highly potent.”

    From A new era in ovulation induction (2006) · cites this paper as [39]

  • Letrozole and anastrazole are completely absorbed after oral administration, with a mean half-life of approximately 45 hours (range, 30-60 hours).

    “Letrozole and anastrazole are completely absorbed after oral administration, with a mean half-life of approximately 45 hours (range, 30 -60 hours).”

    From A new era in ovulation induction (2006) · cites this paper as [39]

  • At doses of 1-5 mg, anastrozole and letrozole decrease E levels by 97%-99%.

    “Their intrinsic potency is considerably greater than that of aminoglutethimide, and at doses of 1-5 mg decreases E levels by 97%-Ͼ99%.”

    From A new era in ovulation induction (2006) · cites this paper as [39]

  • Aromatase inhibitors are orally administered, easy to use, and relatively inexpensive, with minor side effects.

    “They are orally administered, easy to use, and relatively inexpensive, with minor side effects.”

    From A new era in ovulation induction (2006) · cites this paper as [39]

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Authors
Dranitsaris, G., Leung, P., Mather, J., & Oza, A.
Affiliations
  • University of Toronto (CA)
  • Princess Margaret Cancer Centre (CA)
Corresponding author
Dranitsaris, George
ORCID
Venue
Anti-Cancer Drugs
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2000-08
Volume
11
Issue
7
Pages
591-601
ISSN
0959-4973 (ISSN-L)
DOI
10.1097/00001813-200008000-00012
OpenAlex
W2327085958
Cited by
38
References
27
Citations by year
2016: 2 · 2015: 1 · 2014: 1
FWCI
11.20
Type
journal article
Language
en
Open access
closed
Locations
  • Anti-Cancer Drugs (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
  • Health Sciences › Medicine › Oncology › Bone health and treatments
Keywords
advanced breast cancer, second-line hormonal therapy, aromatase inhibitors, anastrozole, letrozole, megestrol acetate, cost-utility analysis, cost-effectiveness, decision models, time trade-off, hospital resource utilization, palliative care, postmenopausal women
MeSH terms
Letrozole, Anastrozole, Antineoplastic Agents, Breast Neoplasms, Canada, Costs and Cost Analysis, Decision Support Techniques, Female, Humans, Nitriles, Quality of Life, Triazoles, Randomized Controlled Trials as Topic, Megestrol Acetate, Aromatase Inhibitors

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