Cost-Effectiveness of Zoledronic Acid Plus Endocrine Therapy in Premenopausal Women With Hormone-Responsive Early Breast Cancer |
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| Authors: | Thomas E. Delea Charu Taneja Oleg Sofrygin Satyin Kaura Michael Gnant |
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| Affiliation: | 1. Policy Analysis Inc., Brookline, MA;2. Novartis Pharmaceuticals Inc., Florham Park, NJ;3. Department of Surgery, Medical University of Vienna, Austria;1. German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany;2. Luisenkrankenhaus Düsseldorf, Hans-Günther-Sohl-Straße 6-10, 40235 Düsseldorf, Germany;3. Hämatologisch-Onkologische Gemeinschaftspraxis Bethanien, Im Prüfling 17-19, 60389 Frankfurt/Main, Germany;4. Universitäts-Frauenklinik Ulm, Prittwitzstraße 43, 89081 Ulm, Germany;5. Universitäts-Frauenklinik Rostock, Südring 81, 18059 Rostock, Germany;6. SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548 Gera, Germany;7. Eilenriede Krankenhaus, Uhlemeyerstraße 16, 30175 Hannover, Germany;8. Universitäts-Frauenklinik Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany;9. Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Austria;10. Charité-Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany;11. Rotkreuzklinikum München, Taxisstr. 3, 80637 München, Germany;12. Klinikum Offenbach, Starkenburgring 66, 63069 Offenbach, Germany;13. Brustzentrum, Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany;14. Universitätsfrauenklinik Erlangen, Universitätsstr. 21-23, 91054 Erlangen, Germany;15. Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany;p. Universitäts-Frauenklinik rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany;q. Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany;1. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK;2. Massachusetts General Hospital, Boston, MA, USA;3. Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil;4. Instituto de Investigacion Sanitaria Gregorio Marañon, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain;5. Aichi Cancer Center Hospital, Nayoya, Japan;6. Hospital Pérola Byington and Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil;7. UCLA School of Medicine, Los Angeles, CA, USA;8. Hospital Universitario Virgen del Rocio, Sevilla, Spain;9. Cross Cancer Institute, Edmonton, AB, Canada;10. Oncology Center, AZ Nikolass, Sint-Niklaas, Belgium;11. Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;12. All-Ireland Co-Operative Oncology Research Group, Dublin, Ireland;13. Institut Gustave Roussy, Villejuif, France;14. Amgen Inc, Thousand Oaks, CA, USA;15. Breast Cancer Research Centre Western Australia and School of Medicine, Curtin University, Perth, WA, Australia;1. Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy;2. Endoscopy Service, Department of Medicine, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy;3. Gastroenterology Unit, Villa Sofia – V. Cervello Hospital, Palermo, Italy;4. UOD Digestive Endoscopy, University of Messina, Messina, Italy;5. Endoscopic Surgery, ASP 5, Messina, Italy;6. Gastroenterology and Digestive Endoscopy Unit, San Raffaele-Giglio Hospital, Cefalù (PA), Italy;7. Gastroenterology Unit, ARNAS Garibaldi Hospital, Catania, Italy;8. Gastroenterology Unit, S. Vincenzo Hospital, Taormina (ME), Italy;1. Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan;2. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan;3. Department of Breast Surgery, Hirosaki Municipal Hospital, Hirosaki, Japan;4. Department of Breast and Thyroid Surgery, Kitasato University Hospital, Sagamihara, Japan;5. Department of Breast and Endocrine Surgery, Gunma University Hospital, Maebashi, Japan;6. Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan;7. Department of Breast Oncology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan;8. Department of Breast Oncology, Kobe Kaisei Hospital, Kobe, Japan;1. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada;2. Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, 200 Elizabeth Street, Suite RFE3-805, Toronto, Ontario, M5G 2C4, Canada;1. CR-UK/YCR Sheffield Cancer Research Centre, Weston Park Hospital, University of Sheffield, Sheffield, UK;2. Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, Edinburgh, UK;3. St James Institute of Oncology, University of Leeds, Leeds, UK;4. Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK;5. Andrew Love Cancer Centre, Geelong, VIC, Australia;6. University Hospital Galway, Galway, Ireland;7. Institut Català d''Oncologia – IDIBELL. L''Hospitalet de Llobregat, Barcelona, Spain;8. University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK;9. Velindre Cancer Center, Whitchurch, Cardiff, UK;10. Beatson West of Scotland Cancer Centre, Glasgow, UK |
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| Abstract: | PurposeThe aim of this study was to estimate the cost-effectiveness of adding zoledronic acid 4 mg intravenously every 6 months to endocrine therapy in premenopausal women with hormone receptor—positive early breast cancer from a US health care system perspective.Materials and MethodsA Markov model was developed to predict disease progression, mortality, and costs of breast cancer care for premenopausal women with hormone receptor—positive early breast cancer receiving up to 3 years of (1) endocrine therapy (goserelin plus tamoxifen or anastrozole); or (2) endocrine therapy plus zoledronic acid. Model parameters were obtained from ABCSG-12 (Austrian Breast and Colorectal Cancer Study Group Trial-12) and the literature. The incremental cost per quality-adjusted life year (QALY) gained with zoledronic acid was calculated under 2 scenarios: (1) benefits of zoledronic acid persist to maximum (7 years) follow-up in ABCSG-12 (“trial benefits”) or (2) benefits persist until death (“lifetime benefits”).ResultsAdding zoledronic acid to endocrine therapy was projected to yield a gain of 0.41 life years (LYs) and 0.43 QALYs assuming trial benefits and 1.34 LYs and 1.41 QALYs assuming lifetime benefits. Assuming trial benefits, the incremental cost per QALY gained with zoledronic acid was $9300. Assuming lifetime benefits, zoledronic acid was estimated to increase QALYs and reduce costs. Cost per QALY gained was ≤ $56,000 in all deterministic sensitivity analyses and was ≤ $50,000 in 94% and 97% of probabilistic sensitivity analyses for trial and lifetime benefits scenarios, respectively.ConclusionAdding zoledronic acid to endocrine therapy in premenopausal women with hormone receptor—positive early breast cancer is cost-effective from a US health care system perspective. |
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