Holmes, G.R. orcid.org/0000-0002-8861-9638, Ward, S.E., Brennan, A. orcid.org/0000-0002-1025-312X et al. (27 more authors) (2021) Cost-effectiveness modeling of surgery plus adjuvant endocrine therapy versus primary endocrine therapy alone in UK women aged 70 and over with early breast cancer. Value in Health, 24 (6). pp. 770-779. ISSN 1098-3015
Abstract
Objectives
Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET for women with varying health and fitness, identifying subgroups for which each treatment is cost-effective.
Methods
Survival outcomes from a statistical model, and published data on recurrence, were combined with data from a large, multicenter, prospective cohort study of over 3400 UK women aged 70+ with early breast cancer and median 52-month follow-up, to populate a probabilistic economic model. This model evaluated the cost-effectiveness of surgery plus adjuvant therapies relative to PET for 24 illustrative subgroups: Age {70, 80, 90} × Nodal status {FALSE (F), TRUE (T)} × Comorbidity score {0, 1, 2, 3+}.
Results
For a 70-year-old with no lymph node involvement and no comorbidities (70, F, 0), surgery plus adjuvant therapies was cheaper and more effective than PET. For other subgroups, surgery plus adjuvant therapies was more effective but more expensive. Surgery plus adjuvant therapies was not cost-effective for 4 of the 24 subgroups: (90, F, 2), (90, F, 3), (90, T, 2), (90, T, 3).
Conclusion
From a UK perspective, surgery plus adjuvant therapies is clinically effective and cost-effective for most women aged 70+ with early breast cancer. Cost-effectiveness reduces with age and comorbidities, and for women over 90 with multiple comorbidities, there is little cost benefit and a negative impact on quality of life.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. This is an author produced version of a paper subsequently published in Value in Health. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | breast cancer; health economic analysis; older women; primary endocrine therapy; surgery |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number NIHR Central Commissioning Facility NIHRDH-RP-PG-1209-10071 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 29 Apr 2021 09:56 |
Last Modified: | 15 Apr 2022 00:38 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.jval.2020.12.016 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:173573 |
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Filename: Supplementary Material updated 4.1.pdf
Licence: CC-BY-NC-ND 4.0