Annemans Lieven
Department of Public Health, Ghent University, Ghent, Belgium.
Pharmacoeconomics. 2008;26(5):409-23. doi: 10.2165/00019053-200826050-00005.
The optimal adjuvant hormonal strategy in post-menopausal women with early breast cancer is a subject of ongoing debate. Aromatase inhibitors (AIs) have been successfully evaluated in clinical trials that have compared them with a standard treatment of 5 years of tamoxifen. However, several options are available in terms of treatment schedule and selected drug. Systematic reviews of clinical trials and health economic evaluations attempt to contribute to the debate. The objective of this paper is to provide a critical review of existing health economic evaluations with a focus on those parameters and assumptions with the largest impact on final outcomes.A wide range of different inputs and assumptions exist, which make a comparison of results difficult, if not impossible. In particular, the modelling of recurrence rates over longer time horizons than those observed in clinical trials, a cornerstone of health economic modelling, is subject to quite different approaches. The practice of indirect comparison of different AIs without sufficiently acknowledging population differences is also bothersome. A list of key features (related to time horizon, clinical data input, patient subtypes, budget impact and model calibration) that an ideal model should have in order to better assist decision makers in this field is proposed.
绝经后早期乳腺癌患者的最佳辅助激素治疗策略一直是一个存在争议的话题。在与5年他莫昔芬标准治疗的对比临床试验中，芳香化酶抑制剂（AIs）已得到成功评估。然而，在治疗方案和所选药物方面有多种选择。对临床试验的系统评价和卫生经济学评估试图为这场争论提供参考。本文的目的是对现有的卫生经济学评估进行批判性综述，重点关注那些对最终结果影响最大的参数和假设。存在大量不同的输入和假设，这使得即使不是不可能，也很难对结果进行比较。特别是，在比临床试验观察到的更长时间范围内对复发率进行建模，这是卫生经济学建模的基石，其方法差异很大。在没有充分考虑人群差异的情况下对不同芳香化酶抑制剂进行间接比较的做法也很麻烦。本文提出了一个理想模型应具备的关键特征列表（与时间范围、临床数据输入、患者亚型、预算影响和模型校准有关），以便更好地协助该领域的决策者。
