Delea Thomas E, Karnon Jonathan, Smith Robert E, Johnston Stephen R D, Brandman Jane, Sung Jennifer C Y, Gross Paul E
Policy Analysis Inc, 4 Davis Court, Brookline, MA 02245, USA.
Am J Manag Care. 2006 Jul;12(7):374-86.
To estimate the cost-effectiveness of extended adjuvant letrozole in postmenopausal women with early breast cancer and estrogen or progesterone receptor-positive tumors who had completed 5 years of adjuvant tamoxifen.
Cost-effectiveness analysis using a Markov model.
Using a Markov model, we estimated the incremental cost per quality-adjusted life-year (QALY) gained with extended adjuvant letrozole vs no extended adjuvant therapy. Probabilities of breast cancer recurrence or new contralateral tumor adverse effects and death were estimated using data from the MA.17 study and other secondary sources. Costs (in 2004 US dollars) and quality-of-life effects (utilities) of breast cancer events and adverse effects were derived from the literature.
In base-case analyses, extended adjuvant letrozole vs no extended adjuvant therapy results in an expected gain of 0.34 QALYs per patient (13.62 vs 13.28 QALYs), at an additional lifetime cost of 9699 dollars per patient (55,254 dollars vs 45,555 dollars). The incremental cost per QALY gained with letrozole is 28,728 dollars. Cost-effectiveness is sensitive to the assumed reduction in risk of breast cancer events with letrozole but is insensitive to the risks, costs, and quality-of-life effects of osteoporosis and hip fracture. Cost-effectiveness is less than 100,000 dollars per QALY for node-positive patients younger than 81 years and for node-negative patients younger than 73 years.
For postmenopausal women with early breast cancer who have completed 5 years of adjuvant tamoxifen, the cost-effectiveness of extended adjuvant letrozole is within the range of other generally accepted medical interventions in the United States.
评估来曲唑延长辅助治疗在完成5年他莫昔芬辅助治疗的绝经后早期乳腺癌且雌激素或孕激素受体阳性肿瘤患者中的成本效益。
使用马尔可夫模型进行成本效益分析。
我们使用马尔可夫模型估计了来曲唑延长辅助治疗与不进行延长辅助治疗相比每获得一个质量调整生命年（QALY）的增量成本。使用MA.17研究和其他二级来源的数据估计乳腺癌复发、新发对侧肿瘤不良事件及死亡的概率。乳腺癌事件和不良事件的成本（以2004年美元计）及生活质量影响（效用值）来自文献。
在基础病例分析中，来曲唑延长辅助治疗与不进行延长辅助治疗相比，每位患者预期可多获得0.34个QALY（分别为13.62个和13.28个QALY），每位患者的额外终生成本为9699美元（分别为55254美元和45555美元）。来曲唑每获得一个QALY的增量成本为28728美元。成本效益对来曲唑降低乳腺癌事件风险的假设敏感，但对骨质疏松症和髋部骨折的风险、成本及生活质量影响不敏感。对于年龄小于81岁的淋巴结阳性患者和年龄小于73岁的淋巴结阴性患者，成本效益低于每QALY 100000美元。
对于完成5年他莫昔芬辅助治疗的绝经后早期乳腺癌患者，来曲唑延长辅助治疗的成本效益在美国其他普遍接受的医学干预范围内。
