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Methodological Issues in Evaluating Cost Effectiveness of Adjuvant Aromatase Inhibitors in Early Breast Cancer
- Source :
- PharmacoEconomics. 26:409-423
- Publication Year :
- 2008
- Publisher :
- Springer Science and Business Media LLC, 2008.
-
Abstract
- The optimal adjuvant hormonal strategy in post-menopausal women with early breast cancer is a subject of ongoing debate. Aromatase inhibitors (AIs) have been successfully evaluated in clinical trials that have compared them with a standard treatment of 5 years of tamoxifen. However, several options are available in terms of treatment schedule and selected drug. Systematic reviews of clinical trials and health economic evaluations attempt to contribute to the debate. The objective of this paper is to provide a critical review of existing health economic evaluations with a focus on those parameters and assumptions with the largest impact on final outcomes. A wide range of different inputs and assumptions exist, which make a comparison of results difficult, if not impossible. In particular, the modelling of recurrence rates over longer time horizons than those observed in clinical trials, a cornerstone of health economic modelling, is subject to quite different approaches. The practice of indirect comparison of different AIs without sufficiently acknowledging population differences is also bothersome. A list of key features (related to time horizon, clinical data input, patient subtypes, budget impact and model calibration) that an ideal model should have in order to better assist decision makers in this field is proposed.
- Subjects :
- medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Population
Breast Neoplasms
Time horizon
Risk Assessment
chemistry.chemical_compound
breast cancer
Exemestane
Humans
Medicine
Economics, Pharmaceutical
education
Pharmacology
education.field_of_study
Health economics
Cost–benefit analysis
Aromatase Inhibitors
business.industry
Health Policy
Public Health, Environmental and Occupational Health
Surgery
Clinical trial
Models, Economic
Systematic review
chemistry
Risk analysis (engineering)
Female
business
Subjects
Details
- ISSN :
- 11707690
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- PharmacoEconomics
- Accession number :
- edsair.doi.dedup.....505ba5c8d732ba6c08122c8a28b4ec7b