Is adjuvant therapy for older patients with node (-) early breast cancer cost-effective?

Abstract

Background: Node (-) breast cancer represents over 60% of cases in older women and currently there is a debate whether adjuvant therapy for these women is cost-effective.

Purpose: Evaluate if adjuvant treatment for early-stage node (-) breast cancer with hormone therapy, chemotherapy, or combination therapy is cost-effective in older patients.

Design: Decision-analysis modeling using life tables integrated the cost of treatment in dollars and impact in length and quality of life. The primary data sources were meta-analysis from the Early Breast Cancer Trialists' Collaborative Group and the Red Book Average Wholesale Price for drugs. The incremental cost-effectiveness of different treatment strategies were then compared and mapped graphically.

Results: Adjuvant therapy is cost-effective in 65-year-old women with early breast cancer. In a 75-year-old estrogen receptor, ER (+) patient, hormone therapy, specifically tamoxifen, is cost-effective, 19,530 dollars/QALY. In a 75-year-old ER (-) the use of chemotherapy (AC or CMF) or 85-year-old ER (+) the use of hormone therapy was only marginally cost-effective, 54,000-76,000 dollars/QALY, only if efficacy was assumed to be age-insensitive (similar to a 65-year-old woman).

Conclusion: Decision-analytic models can help policy makers who are faced with decisions about whether to support adjuvant therapy in older breast cancer patients and also outline the important parameters that need to be considered in such a decision.