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Economic evaluation of fulvestrant as an extra step in the treatment sequence for ER-positive advanced breast cancer.

Cameron DA, Camidge DR, Oyee J, Hirsch M - Br. J. Cancer (2008)

Bottom Line: Fulvestrant was found to be a cost-effective treatment option when added to the treatment sequence as a second- or third-line hormonal therapy for advanced disease.When used as a third-line option, the fulvestrant arm was dominant providing an increase in health benefit of 27 QALYs for the whole cohort, at a mean overall cost reduction of pound 430 per patient.Sensitivity analyses showed these results to be robust, demonstrating that fulvestrant is an economically viable additional endocrine option in the United Kingdom for the treatment of hormone responsive advanced breast cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Western General Hospital, Edinburgh, UK.

ABSTRACT
Drug therapies for advanced breast cancer in hormone-receptor-positive disease include both hormonal and chemotherapies. Current UK practice is to minimise toxicity by using sequential hormonal agents for as long as clinically appropriate. A Markov model was developed to investigate the cost effectiveness of different sequences of therapies, particularly exploring the effects of adding an additional hormonal agent, fulvestrant, to the treatment pathway. A systematic review was undertaken and a panel of seven UK oncologists validated assumptions used for treatment efficacy, treatment pathways and resources used. Fulvestrant was found to be a cost-effective treatment option when added to the treatment sequence as a second- or third-line hormonal therapy for advanced disease. For a cohort of 1000 patients, fulvestrant as a second-line hormone therapy provided an additional 47 life years and 41 quality-adjusted life years (QALYs), at an additional cost of pound 301 359. This equated to pound 6500 per life years gained and pound 7500 per QALY. When used as a third-line option, the fulvestrant arm was dominant providing an increase in health benefit of 27 QALYs for the whole cohort, at a mean overall cost reduction of pound 430 per patient. Sensitivity analyses showed these results to be robust, demonstrating that fulvestrant is an economically viable additional endocrine option in the United Kingdom for the treatment of hormone responsive advanced breast cancer.

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Related in: MedlinePlus

Overview of the sequencing model patient.
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fig2: Overview of the sequencing model patient.

Mentions: At the end of each Markov cycle, patients could either remain on their current line of treatment, experience disease progression and move to another line of treatment or die. The probability of any of these events occurring is dependent on treatment-specific median time to progression (TTP) data and the probability of dying on each treatment. Once patients had experienced a progressive event they could move to any later health states to reflect actual clinical practice. The health states and possible transitions of patients for each cohort are shown in Figure 2.


Economic evaluation of fulvestrant as an extra step in the treatment sequence for ER-positive advanced breast cancer.

Cameron DA, Camidge DR, Oyee J, Hirsch M - Br. J. Cancer (2008)

Overview of the sequencing model patient.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2607221&req=5

fig2: Overview of the sequencing model patient.
Mentions: At the end of each Markov cycle, patients could either remain on their current line of treatment, experience disease progression and move to another line of treatment or die. The probability of any of these events occurring is dependent on treatment-specific median time to progression (TTP) data and the probability of dying on each treatment. Once patients had experienced a progressive event they could move to any later health states to reflect actual clinical practice. The health states and possible transitions of patients for each cohort are shown in Figure 2.

Bottom Line: Fulvestrant was found to be a cost-effective treatment option when added to the treatment sequence as a second- or third-line hormonal therapy for advanced disease.When used as a third-line option, the fulvestrant arm was dominant providing an increase in health benefit of 27 QALYs for the whole cohort, at a mean overall cost reduction of pound 430 per patient.Sensitivity analyses showed these results to be robust, demonstrating that fulvestrant is an economically viable additional endocrine option in the United Kingdom for the treatment of hormone responsive advanced breast cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Western General Hospital, Edinburgh, UK.

ABSTRACT
Drug therapies for advanced breast cancer in hormone-receptor-positive disease include both hormonal and chemotherapies. Current UK practice is to minimise toxicity by using sequential hormonal agents for as long as clinically appropriate. A Markov model was developed to investigate the cost effectiveness of different sequences of therapies, particularly exploring the effects of adding an additional hormonal agent, fulvestrant, to the treatment pathway. A systematic review was undertaken and a panel of seven UK oncologists validated assumptions used for treatment efficacy, treatment pathways and resources used. Fulvestrant was found to be a cost-effective treatment option when added to the treatment sequence as a second- or third-line hormonal therapy for advanced disease. For a cohort of 1000 patients, fulvestrant as a second-line hormone therapy provided an additional 47 life years and 41 quality-adjusted life years (QALYs), at an additional cost of pound 301 359. This equated to pound 6500 per life years gained and pound 7500 per QALY. When used as a third-line option, the fulvestrant arm was dominant providing an increase in health benefit of 27 QALYs for the whole cohort, at a mean overall cost reduction of pound 430 per patient. Sensitivity analyses showed these results to be robust, demonstrating that fulvestrant is an economically viable additional endocrine option in the United Kingdom for the treatment of hormone responsive advanced breast cancer.

Show MeSH
Related in: MedlinePlus