Department of Radiation Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, China.
Department of Breast Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, China.
Biomed Res Int. 2018 Aug 2;2018:9282646. doi: 10.1155/2018/9282646. eCollection 2018.
Long-term aromatase inhibitor (AI) therapy is expected to improve the health outcomes with high health resource consumption in early breast cancer. The aim of the study was to assess the cost-effectiveness of letrozole for postmenopausal women with estrogen receptor positive early breast cancer in a health resource-limited setting.
A Markov model was developed to project the lifetime outcomes based on the clinical course of early breast cancer. The clinical and utility data were derived from reported results. Costs were estimated from the perspective of Chinese health care. The quality-adjusted life-year (QALY) and incremental cost-effective ratio (ICER) were measured. Probabilistic sensitivity and one-way analyses were conducted.
Compared to 5 years of tamoxifen therapy, 5 years of AI treatment with letrozole improved the QALYs (10.44 versus 10.84) and increased the lifetime costs (CNY ¥13,613 versus CNY ¥28,797), resulting in an ICER of CNY ¥38,092 /QALY. The ICER of 5 years of letrozole versus 2-3 years of tamoxifen and then letrozole was CNY ¥68,233 /QALY. Sensitivity analyses showed that the age of initiating adjuvant endocrine therapy was the most influential parameter.
In health resource-limited settings, adjuvant endocrine therapy with letrozole is a cost-effective strategy compared to tamoxifen in women with early breast cancer.
长期使用芳香化酶抑制剂（AI）治疗有望改善高健康资源消耗的早期乳腺癌患者的健康结局。本研究旨在评估来曲唑在资源有限的环境中用于治疗雌激素受体阳性早期乳腺癌绝经后妇女的成本效果。
建立了一个马尔可夫模型，根据早期乳腺癌的临床过程预测其终身结局。临床和效用数据来自报告的结果。成本从中国医疗保健的角度进行估算。测量了质量调整生命年（QALY）和增量成本效果比（ICER）。进行了概率敏感性和单向分析。
与 5 年他莫昔芬治疗相比，5 年来曲唑的 AI 治疗改善了 QALY（10.44 比 10.84），增加了终身成本（CNY ¥13613 比 CNY ¥28797），导致 ICER 为 CNY ¥38092/QALY。5 年来曲唑与 2-3 年来曲唑然后来曲唑的 ICER 为 CNY ¥68233/QALY。敏感性分析表明，开始辅助内分泌治疗的年龄是最具影响力的参数。
在资源有限的环境中，与他莫昔芬相比，来曲唑作为早期乳腺癌妇女的辅助内分泌治疗是一种具有成本效益的策略。
