Two Adjuvant Treatments for Breast Cancer Earn Their Keep

TORONTO, June 26 -- Two well-accepted adjuvant therapies for early breast cancer proved cost-effective for improving survival, according to a pair of studies.
Both exemestane (Aromasin) and trastuzumab (Herceptin) have been proven effective in adjuvant breast cancer therapy, and the drugs are included in professional treatment guidelines.

But given their cost, one set of researchers in Canada and another in the U.S. evaluated the cost-effectiveness of the drugs, and reported their findings online in Cancer, with publication in the Aug. 1 issue of the journal.

Each study, one for each drug, found a low projected lifetime cost under $30,000 per life-year gained, adjusted for quality of life.

In the Canadian study of postmenopausal women with estrogen-receptor-positive breast cancer, switching to adjuvant exemestane, an aromatase inhibitor, after two or three years of tamoxifen (Nolvadex) extended disease-free survival at a minimal cost of under $3,000 per patient per year over 7.5 years, Nicole Mittmann, M.Sc., Ph.D., of the University of Toronto, and colleagues found.

Their analysis used a hypothetical cohort of postmenopausal women from the recent Intergroup Exemestane Study (IES), which found a survival benefit for switching to exemestane.

Disease progression and hazard ratios for recurrence and survival were determined from IES datasets, the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, and from published literature.

Cost-effectiveness, from a government-payer perspective, was measured not only in life years gained but was adjusted for gain in quality of life. The combination was expressed as quality-adjusted life years gained.

Five years after completing adjuvant therapy (a total of 7.5 years) a tamoxifen-exemestane adjuvant protocol improved absolute disease-free survival by 2.6% (80.9% versus 78% for tamoxifen alone).

Compared with continued tamoxifen, sequential therapy with tamoxifen and exemestane increased the total discounted medical costs in Canadian dollars by $2,889 per patient over 7.5 years.

Cost savings in the exemestane group for reduced cancer recurrence were $1,680 per person and for other cancers, $221 per person.

The incremental cost-effectiveness ratio for exemestane was $28,119 per life year gained.

Calculated as the quality-adjusted life year gained, the incremental cost-utility ratio was $24,185.

source : www.medpagetoday.com