1. Cost-effectiveness of adjuvant endocrine treatment with tamoxifen for male breast cancer.
- Author
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Huang Y, Ke C, Cai J, Wei X, Chen M, and Sun H
- Subjects
- Humans, Male, Chemotherapy, Adjuvant economics, Chemotherapy, Adjuvant methods, Middle Aged, Aged, Receptors, Estrogen metabolism, Medication Adherence statistics & numerical data, United States, Tamoxifen therapeutic use, Tamoxifen economics, Cost-Benefit Analysis, Antineoplastic Agents, Hormonal therapeutic use, Antineoplastic Agents, Hormonal economics, Breast Neoplasms, Male drug therapy, Breast Neoplasms, Male economics, Quality-Adjusted Life Years, Markov Chains
- Abstract
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., (© 2024. The Author(s), under exclusive licence to The Japanese Breast Cancer Society.)
- Published
- 2024
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