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- Article] Cost-effectiveness analysis of anastrozole vs tamoxifen in adjuvant therapy for early stage breast cancer in the United Kingdom: the 5-year completed treatment analysis of the ATAC ('Arimidex', Tamoxifen alone or in combination) trial
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DocNo of ILP: 4205
Doc. Type: Article
Title: Cost-effectiveness analysis of anastrozole vs tamoxifen in adjuvant therapy for early stage breast cancer in the United Kingdom: the 5-year completed treatment analysis of the ATAC ('Arimidex', Tamoxifen alone or in combination) trial
Authors: Mansel, R; Locker, G; Fallowfield, L; Benedict, A; Jones, D
Full Name of Authors: Mansel, R.; Locker, G.; Fallowfield, L.; Benedict, A.; Jones, D.
Keywords by Author: anastrozole; tamoxifen; aromatase inhibitor; breast cancer; cost-effectiveness analysis; cost-utility analysis
Keywords Plus: QUALITY-OF-LIFE; POSTMENOPAUSAL WOMEN; RANDOMIZED-TRIALS; CHEMOTHERAPY; UK; RECURRENCE; SURVIVAL
Abstract: Results from the completed treatment analysis of the ATAC (Arimidex, Tamoxifen alone or in combination) trial indicated that anastrozole was significantly superior to tamoxifen in terms of efficacy and safety in the adjuvant treatment of postmenopausal women with hormone receptor-positive (HR dagger) early breast cancer. On the basis of these results, this study estimated the cost-effectiveness of anastrozole vs tamoxifen, from the perspective of the UK National Health Service (NHS). A Markov model was developed using the 5- year completed treatment analysis from the ATAC trial (ISRCTN18233230), as well as data obtained from published literature and expert opinion. Resource utilisation data and associated costs (2003-4 UK ) pound were compiled from standard sources and expert opinion. Utility scores for a number of health states were obtained from a cross- sectional study of 26 representative patients using the standard gamble technique. The utility scores were then inserted into the model to obtain cost per quality adjusted life- year (QALY) gained. Costs and benefits were discounted at recommended annual rates of the UK Treasury (3.5%). Modelled for 25 years, anastrozole, relative to generic tamoxifen, was estimated to result in 0.244 QALYs gained per patient at an additional cost of 4315 pound per patient). The estimated incremental cost- effectiveness of anastrozole compared with tamoxifen was 17 pound 656 per QALY gained. There was a greater than 90% probability that the cost-effectiveness of anastrozole was below 30 pound 000 per QALY gained and of the order of 65% that it was below 20 pound 000 per QALY gained. The results were robust to all parameters tested in sensitivity analysis. Compared with commonly accepted thresholds, anastrozole is a cost- effective alternative to generic tamoxifen in adjuvant treatment of postmenopausal women with HR dagger early breast cancer from the UK NHS perspective.
Cate of OECD: Clinical medicine
Year of Publication: 2007
Business Area: other
Detail Business: medicine & science
Country: England
Study Area: culture, quality of life, utility, utility, probability, probability, patient, cancer
Name of Journal: BRITISH JOURNAL OF CANCER
Language: English
Country of Authors: Univ Cardiff Wales, Coll Med, Dept Surg, Cardiff CF14 4XN, S Glam, Wales; Evanston Northwestern Healthcare, Dept Oncol, Evanston, IL USA; Brighton & Sussex Med Sch, Dept Pyschooncol, Brighton BN1 9QG, E Sussex, England; MEDTAP Int Inc, London WC1A 2NS, England; AstraZeneca, Macclesfield SK10 4TF, Cheshire, England
Press Adress: Mansel, R (reprint author), Univ Cardiff Wales, Coll Med, Dept Surg, Heath Pk, Cardiff CF14 4XN, S Glam, Wales.
Email Address: manselre@aol.com
Citaion:
Funding:
Lists of Citation: Abe O, 2005, LANCET, V365, P1687; *ATAC TRIAL GROUP, 2003, CANCER, V98, P1802, DOI DOI 10.1002/CNCR.11745; Benedict A, 2003, VALUE HEALTH, V6, P735; Briggs AH, 2001, EC EVALUATION HLTH C, P172; Cella D, 2006, BREAST CANCER RES TR, V100, P273, DOI 10.1007/s10549-006-9260-6; COOK PJ, 1969, INT J CANCER, V4, P93, DOI 10.1002/ijc.2910040113; Coyle D, 1999, CRIT REV ONCOL HEMAT, V32, P71, DOI 10.1016/S1040-8428(99)00023-2; Clarke M, 1998, LANCET, V351, P1451; Fallowfield L, 2004, J CLIN ONCOL, V22, P4261, DOI 10.1200/JCO.2004.08.029; Fisher B, 2001, J NATL CANCER I, V93, P684, DOI 10.1093/jnci/93.9.684; Gordois A, 2003, J THROMB HAEMOST, V1, P2167, DOI 10.1046/j.1538-7836.2003.00396.x; Hillner BE, 2004, CANCER, V101, P1311, DOI 10.1002/cncr.20492; Howell A, 2005, LANCET, V365, P60; Iglesias CP, 2002, QJM-INT J MED, V95, P305, DOI 10.1093/qjmed/95.5.305; Kamby C, 1997, BREAST CANCER RES TR, V45, P181, DOI 10.1023/A:1005845100512; Karnon J, 2002, PHARMACOECONOMICS, V20, P119, DOI 10.2165/00019053-200220020-00005; Lamerato L, 2004, 27 ANN SAN ANT BREAS; LOCKER GY, 2004, 27 ANN SAN ANT BREAS; LOVE RR, 1991, ANN INTERN MED, V115, P860; Moran Meena S, 2002, Breast J, V8, P81, DOI 10.1046/j.1524-4741.2002.08202.x; *NAT I HLTH CLIN E, 2003, GUID US IM CHR MY LE; *NIHCE, 2002, 34 NIHCE; Peto R, 2000, LANCET, V355, P1822, DOI 10.1016/S0140-6736(00)02277-7; Reddy P, 2000, AM J HEALTH-SYST PH, V57, P1315; Sculpher M, 2005, VALUE HEALTH, V8, P433, DOI 10.1111/j.1524-4733.2005.00033.x; SONNENBERG FA, 1993, MED DECIS MAKING, V13, P322, DOI 10.1177/0272989X9301300409; Stockler M, 2000, CANCER TREAT REV, V26, P151, DOI 10.1053/ctrv.1999.0161; TORRANCE GW, 1986, J HEALTH ECON, V5, P1, DOI 10.1016/0167-6296(86)90020-2; Towse A, 2002, COST EFFECTIVENESS T, P25; VANHOUT BA, 1994, HEALTH ECON, V3, P309, DOI 10.1002/hec.4730030505; Winer EP, 2005, J CLIN ONCOL, V23, P619, DOI 10.1002/JCO.2005.09.121
Number of Citaion: 31
Publication: NATURE PUBLISHING GROUP
City of Publication: LONDON
Address of Publication: MACMILLAN BUILDING, 4 CRINAN ST, LONDON N1 9XW, ENGLAND
ISSN: 0007-0920
29-Character Source Abbreviation: BRIT J CANCER
ISO Source Abbreviation: Br. J. Cancer
Volume: 97
Version: 2
Start of File: 152
End of File: 161
DOI: 10.1038/sj.bjc.6603804
Number of Pages: 10
Web of Science Category: Oncology
Subject Category: Oncology
Document Delivery Number: 190DY
Unique Article Identifier: WOS:000248039400002
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