Younis T, Rayson D, Dewar R, Skedgel C
Department of Medicine, Dalhousie University at Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Ann Oncol. 2007 Feb;18(2):293-8. doi: 10.1093/annonc/mdl410. Epub 2006 Nov 9.
To determine cost-effective (CE) strategies comparing adjuvant upfront aromatase inhibitor (AI) with sequential tamoxifen (TAM) AI in postmenopausal (PM) women with breast cancer (BC).
A Markov model was constructed to calculate cumulative costs and quality-adjusted life year (QALY) gains for upfront AI and TAM-AI in a hypothetical cohort of 60-year-old PM women with BC. Costs, utilities and probabilities were derived from the literature. The hazard ratios (HRs) of AI strategies were applied to a baseline cancer recurrence risk (RR) to determine CE strategies at the $50,000/QALY gain threshold. A direct payer perspective is utilized, and costs and benefits were discounted at 3%.
Two-way sensitivity analyses are presented to determine CE strategies across a wide range of HRs and in different clinical scenarios including varying RRs (low, average, high and very high). TAM-AI is the preferred CE strategy at low and average RR, while upfront AI is CE at very high RR. The CE strategy in patients with high RR was dependent on the scenario examined.
This model may help health care providers select CE-adjuvant AI strategies in PM women with BC, until further direct evidence is available from randomized clinical trials.
确定在绝经后（PM）乳腺癌（BC）女性中，比较辅助性 upfront 芳香化酶抑制剂（AI）与序贯他莫昔芬（TAM）AI 的成本效益（CE）策略。
构建马尔可夫模型，以计算假设的 60 岁 PM BC 女性队列中 upfront AI 和 TAM-AI 的累积成本和质量调整生命年（QALY）增益。成本、效用和概率均来自文献。将 AI 策略的风险比（HRs）应用于基线癌症复发风险（RR），以确定在每 QALY 增益 50,000 美元阈值下的 CE 策略。采用直接支付方视角，成本和效益按 3%进行贴现。
进行双向敏感性分析，以确定在广泛的 HRs 范围内以及不同临床场景（包括不同的 RR，低、平均、高和非常高）下的 CE 策略。在低和平均 RR 时，TAM-AI 是首选的 CE 策略，而在非常高的 RR 时，upfront AI 具有成本效益。高 RR 患者的 CE 策略取决于所研究的场景。
在有进一步的随机临床试验直接证据之前，该模型可能有助于医疗保健提供者为 PM BC 女性选择具有成本效益的辅助性 AI 策略。
