• Michael P Lux, Achim Wöckel, Agnes Benedict, Stefan Buchholz, Noémi Kreif, Nadia Harbeck, Rolf Kreienberg, Manfred Kaufmann, Matthias W Beckmann, Walter Jonat, Peyman Hadji, Wolfgang Distler, Guenther Raab, Hans Tesch, Georg Weyers, Kurt Possinger, and Andreas Schneeweiss.
• University Breast Center Franconia, University of Erlangen, Germany.
• Onkologie. 2010 Jan 1; 33 (4): 155-66.

BackgroundIn the 'Arimidex', Tamoxifen Alone or in Combination (ATAC) trial, the aromatase inhibitor (AI) anastrozole had a significantly better efficacy and safety profile than tamoxifen as initial adjuvant therapy for hormone receptor-positive (HR+) early breast cancer (EBC) in postmenopausal patients. To compare the combined long-term clinical and economic benefits, we carried out a cost-effectiveness analysis (CEA) of anastrozole versus tamoxifen based on the data of the 100month analysis of the ATAC trial from the perspective of the German public health insurance.Patients And MethodsA Markov model with a 25-year time horizon was developed using the 100-month analysis of the ATAC trial as well as data obtained from published literature and expert opinion.ResultsAdjuvant treatment of EBC with anastrozole achieved an additional 0.32 quality-adjusted life-years (QALYs) gained per patient compared with tamoxifen, at an additional cost of D 6819 per patient. Thus, the incremental cost effectiveness of anastrozole versus tamoxifen at 25 years was D 21,069 ($30,717) per QALY gained.ConclusionsThis is the first CEA of an AI that is based on extended follow-up data, taking into account the carryover effect of anastrozole, which maintains the efficacy benefits beyond therapy completion after 5 years. Adjuvant treatment with anastrozole for postmenopausal women with HR+ EBC is a cost-effective alternative to tamoxifen.Copyright 2010 S. Karger AG, Basel.

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