Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India

Dimple Butani,1 Nidhi Gupta,2 Gaurav Jyani,1 Pankaj Bahuguna,1 Rakesh Kapoor,3 Shankar Prinja1 1Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2Department of Radiation Oncology, Government Medical College and...

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Autores principales: Butani D, Gupta N, Jyani G, Bahuguna P, Kapoor R, Prinja S
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Publicado: Dove Medical Press 2021
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spelling oai:doaj.org-article:9477f24e1a394e24902920eacd82c44f2021-11-28T19:13:10ZCost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India1179-1314https://doaj.org/article/9477f24e1a394e24902920eacd82c44f2021-11-01T00:00:00Zhttps://www.dovepress.com/cost-effectiveness-of-tamoxifen-aromatase-inhibitor-and-switch-therapy-peer-reviewed-fulltext-article-BCTThttps://doaj.org/toc/1179-1314Dimple Butani,1 Nidhi Gupta,2 Gaurav Jyani,1 Pankaj Bahuguna,1 Rakesh Kapoor,3 Shankar Prinja1 1Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India; 3Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Shankar PrinjaDepartment of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaTel +91 9872871978Email shankarprinja@gmail.comBackground: Breast cancer is the leading cause of cancer among women in India. Treatment with hormone therapy reduces recurrence. We undertook this cost-effectiveness study to ascertain the treatment option offering the best value for money.Methods: The lifetime costs and health outcomes of using tamoxifen, AI and switch therapy were measured in a cohort of 50-year-old women with HR-positive early stage breast cancer. A Markov model of disease was developed using a societal perspective with a lifetime study horizon. Local, contralateral, and distant recurrence were modelled along with treatment related adverse effects. Primary data collected to obtain estimates of out-of-pocket expenditure (OOPE) and utility weights. Both health system cost and OOPE were included. The future costs and consequences were discounted at 3%. A probabilistic sensitivity analysis was used.Results: The lifetime cost of hormone therapy with tamoxifen, AI and switch therapy was to be ₹1,472,037 (I$ 68,947), ₹1,306,794 (I$ 61,208) and ₹1,281,811 (I$ 60,038). The QALYs lived per patient receiving tamoxifen, AI and switch were 13.12, 13.42 and 13.32. tamoxifen was found to be more expensive and less effective. As compared to switch therapy, AI for five years incurred an incremental cost of ₹259,792 (I$12,168) per QALY gained. At the willingness to pay equals to per capita GDP of India, there is 55% probability of AI therapy to be cost-effective compared to switch therapy.Conclusion: In postmenopausal women with HR-positive early-stage breast cancer, switch therapy is recommended for use on the basis of cost-effectiveness.Keywords: cost-effectiveness, aromatase inhibitor, tamoxifen, endocrine therapy, breast cancerButani DGupta NJyani GBahuguna PKapoor RPrinja SDove Medical Pressarticlecost-effectivenessaromatase inhibitortamoxifenendocrine therapybreast cancerNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 13, Pp 625-640 (2021)
institution DOAJ
collection DOAJ
language EN
topic cost-effectiveness
aromatase inhibitor
tamoxifen
endocrine therapy
breast cancer
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
spellingShingle cost-effectiveness
aromatase inhibitor
tamoxifen
endocrine therapy
breast cancer
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
RC254-282
Butani D
Gupta N
Jyani G
Bahuguna P
Kapoor R
Prinja S
Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
description Dimple Butani,1 Nidhi Gupta,2 Gaurav Jyani,1 Pankaj Bahuguna,1 Rakesh Kapoor,3 Shankar Prinja1 1Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India; 3Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Shankar PrinjaDepartment of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaTel +91 9872871978Email shankarprinja@gmail.comBackground: Breast cancer is the leading cause of cancer among women in India. Treatment with hormone therapy reduces recurrence. We undertook this cost-effectiveness study to ascertain the treatment option offering the best value for money.Methods: The lifetime costs and health outcomes of using tamoxifen, AI and switch therapy were measured in a cohort of 50-year-old women with HR-positive early stage breast cancer. A Markov model of disease was developed using a societal perspective with a lifetime study horizon. Local, contralateral, and distant recurrence were modelled along with treatment related adverse effects. Primary data collected to obtain estimates of out-of-pocket expenditure (OOPE) and utility weights. Both health system cost and OOPE were included. The future costs and consequences were discounted at 3%. A probabilistic sensitivity analysis was used.Results: The lifetime cost of hormone therapy with tamoxifen, AI and switch therapy was to be ₹1,472,037 (I$ 68,947), ₹1,306,794 (I$ 61,208) and ₹1,281,811 (I$ 60,038). The QALYs lived per patient receiving tamoxifen, AI and switch were 13.12, 13.42 and 13.32. tamoxifen was found to be more expensive and less effective. As compared to switch therapy, AI for five years incurred an incremental cost of ₹259,792 (I$12,168) per QALY gained. At the willingness to pay equals to per capita GDP of India, there is 55% probability of AI therapy to be cost-effective compared to switch therapy.Conclusion: In postmenopausal women with HR-positive early-stage breast cancer, switch therapy is recommended for use on the basis of cost-effectiveness.Keywords: cost-effectiveness, aromatase inhibitor, tamoxifen, endocrine therapy, breast cancer
format article
author Butani D
Gupta N
Jyani G
Bahuguna P
Kapoor R
Prinja S
author_facet Butani D
Gupta N
Jyani G
Bahuguna P
Kapoor R
Prinja S
author_sort Butani D
title Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
title_short Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
title_full Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
title_fullStr Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
title_full_unstemmed Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India
title_sort cost-effectiveness of tamoxifen, aromatase inhibitor, and switch therapy (adjuvant endocrine therapy) for breast cancer in hormone receptor positive postmenopausal women in india
publisher Dove Medical Press
publishDate 2021
url https://doaj.org/article/9477f24e1a394e24902920eacd82c44f
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