Yaping Huang, Chengjie Ke, Jiaqin Cai, Xiaoxia Wei, Maohua Chen, Hong Sun
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Our study aims to analyze the cost-effectiveness of receiving adjuvant endocrine therapy with TAM compared to no TAM, and to assess the cost-effectiveness of using TAM with high adherence over low adherence for ER-positive early male breast cancer in the USA.</p><p><strong>Methods: </strong>Two Markov models comprising three mutually exclusive health states were constructed: (1) the first Markov model compared the cost-effectiveness of adding TAM with not using TAM (TAM versus Not-TAM); (2) the second model compared the cost-effectiveness of receiving TAM with high adherence and low adherence (High-adherence-TAM versus Low-adherence-TAM). The simulation time horizon for both models was the lifetime of patients. The efficacy and safety data of two models were elicited from the real-world studies. Model inputs were derived from the US website and published literature. The main outcomes of two models both included the total cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>In the first model, TAM yielded an ICER of $5707.29 per QALY compared to Not-TAM, which was substantially below the WTP threshold of $50,000.00 per QALY in the USA. Probabilistic sensitivity analysis results demonstrated a 100.00% probability of cost-effectiveness for this strategy. In the second model, High-adherence-TAM was dominated absolutely compared to Low-adherence-TAM. The High-adherence-TAM was cost-effective with a 99.70% probability over Low-adherence-TAM when WTP was set as $50,000.00/QALY. All of these parameters within their plausible ranges did not reversely change the results of our models.</p><p><strong>Conclusions: </strong>Our study will offer valuable guidance for physicians or patients when making treatment decisions and provide an effective reference for decision-making to consider the appropriate allocation of funds to this special group.</p>","PeriodicalId":56083,"journal":{"name":"Breast Cancer","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cost-effectiveness of adjuvant endocrine treatment with tamoxifen for male breast cancer.\",\"authors\":\"Yaping Huang, Chengjie Ke, Jiaqin Cai, Xiaoxia Wei, Maohua Chen, Hong Sun\",\"doi\":\"10.1007/s12282-024-01605-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Tamoxifen (TAM) is recommended as the first-line strategy for men with estrogen receptor (ER)-positive early breast cancer who are candidates for adjuvant endocrine therapy in ASCO guideline. Our study aims to analyze the cost-effectiveness of receiving adjuvant endocrine therapy with TAM compared to no TAM, and to assess the cost-effectiveness of using TAM with high adherence over low adherence for ER-positive early male breast cancer in the USA.</p><p><strong>Methods: </strong>Two Markov models comprising three mutually exclusive health states were constructed: (1) the first Markov model compared the cost-effectiveness of adding TAM with not using TAM (TAM versus Not-TAM); (2) the second model compared the cost-effectiveness of receiving TAM with high adherence and low adherence (High-adherence-TAM versus Low-adherence-TAM). The simulation time horizon for both models was the lifetime of patients. The efficacy and safety data of two models were elicited from the real-world studies. Model inputs were derived from the US website and published literature. The main outcomes of two models both included the total cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>In the first model, TAM yielded an ICER of $5707.29 per QALY compared to Not-TAM, which was substantially below the WTP threshold of $50,000.00 per QALY in the USA. Probabilistic sensitivity analysis results demonstrated a 100.00% probability of cost-effectiveness for this strategy. In the second model, High-adherence-TAM was dominated absolutely compared to Low-adherence-TAM. The High-adherence-TAM was cost-effective with a 99.70% probability over Low-adherence-TAM when WTP was set as $50,000.00/QALY. 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引用次数: 0
摘要
背景：ASCO指南推荐他莫昔芬（TAM）作为雌激素受体（ER）阳性早期乳腺癌男性患者辅助内分泌治疗的一线策略。我们的研究旨在分析与不使用 TAM 相比，使用 TAM 接受辅助内分泌治疗的成本效益，并评估美国 ER 阳性早期男性乳腺癌患者使用高依从性 TAM 而非低依从性 TAM 的成本效益：方法：构建了两个马尔可夫模型，包括三种相互排斥的健康状态：（1）第一个马尔可夫模型比较了添加 TAM 与不使用 TAM 的成本效益（TAM 与 Not-TAM）；（2）第二个模型比较了接受高依从性 TAM 与低依从性 TAM 的成本效益（High-adherence-TAM 与 Low-adherence-TAM）。两个模型的模拟时间范围均为患者的终生。两个模型的疗效和安全性数据均来自真实世界的研究。模型输入数据来自美国网站和公开发表的文献。两个模型的主要结果均包括总成本、质量调整生命年（QALYs）和增量成本效益比（ICERs）：在第一个模型中，TAM 与非 TAM 相比，每 QALY 的 ICER 为 5707.29 美元，大大低于美国每 QALY 50,000.00 美元的 WTP 临界值。概率敏感性分析结果表明，该策略的成本效益概率为 100.00%。在第二个模型中，与低依从性-TAM 相比，高依从性-TAM 占绝对优势。当 WTP 设为 50,000.00 美元/QALY 时，高依从性-TAM 的成本效益概率为 99.70%，而低依从性-TAM 的成本效益概率为 99.70%。所有这些参数在其合理范围内都不会反向改变我们的模型结果：我们的研究将为医生或患者做出治疗决定提供有价值的指导，并为考虑向这一特殊群体适当分配资金提供有效的决策参考。
Cost-effectiveness of adjuvant endocrine treatment with tamoxifen for male breast cancer.
Background: Tamoxifen (TAM) is recommended as the first-line strategy for men with estrogen receptor (ER)-positive early breast cancer who are candidates for adjuvant endocrine therapy in ASCO guideline. Our study aims to analyze the cost-effectiveness of receiving adjuvant endocrine therapy with TAM compared to no TAM, and to assess the cost-effectiveness of using TAM with high adherence over low adherence for ER-positive early male breast cancer in the USA.
Methods: Two Markov models comprising three mutually exclusive health states were constructed: (1) the first Markov model compared the cost-effectiveness of adding TAM with not using TAM (TAM versus Not-TAM); (2) the second model compared the cost-effectiveness of receiving TAM with high adherence and low adherence (High-adherence-TAM versus Low-adherence-TAM). The simulation time horizon for both models was the lifetime of patients. The efficacy and safety data of two models were elicited from the real-world studies. Model inputs were derived from the US website and published literature. The main outcomes of two models both included the total cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
Results: In the first model, TAM yielded an ICER of $5707.29 per QALY compared to Not-TAM, which was substantially below the WTP threshold of $50,000.00 per QALY in the USA. Probabilistic sensitivity analysis results demonstrated a 100.00% probability of cost-effectiveness for this strategy. In the second model, High-adherence-TAM was dominated absolutely compared to Low-adherence-TAM. The High-adherence-TAM was cost-effective with a 99.70% probability over Low-adherence-TAM when WTP was set as $50,000.00/QALY. All of these parameters within their plausible ranges did not reversely change the results of our models.
Conclusions: Our study will offer valuable guidance for physicians or patients when making treatment decisions and provide an effective reference for decision-making to consider the appropriate allocation of funds to this special group.
期刊介绍：
Breast Cancer, the official journal of the Japanese Breast Cancer Society, publishes articles that contribute to progress in the field, in basic or translational research and also in clinical research, seeking to develop a new focus and new perspectives for all who are concerned with breast cancer. The journal welcomes all original articles describing clinical and epidemiological studies and laboratory investigations regarding breast cancer and related diseases. The journal will consider five types of articles: editorials, review articles, original articles, case reports, and rapid communications. Although editorials and review articles will principally be solicited by the editors, they can also be submitted for peer review, as in the case of original articles. The journal provides the best of up-to-date information on breast cancer, presenting readers with high-impact, original work focusing on pivotal issues.
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