Economic Evaluation of Exemestane Versus Tamoxifen in Post-Menopausal Women with Early Breast Cancer from The Egyptian Health Care System Perspective

• Published in: Value in health Vol. 20; no. 9; p. A440
• Main Authors: Elshafei, zA, Abourawash, AS
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01-10-2017
• Subjects: Breast cancer; Cancer therapies; Clinical medicine; Clinical trials; Cost analysis; Death & dying; Economics; Health care expenditures; Hospitals; Medical treatment; Menopausal women; Metastases; Metastasis; Pharmacology; Postmenopausal women; Quality adjusted life years; Recurrence; Sensitivity analysis; Tamoxifen; Egypt
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.240

OBJECTIVES: Breast cancer is the most common cause of cancer death in women worldwide. It imposes a substantial economic burden on the healthcare resources in Egypt each year. It is therefore becoming increasingly important to evaluate the cost-effectiveness of Exemestane 25mg versus Tamoxifen 20mgin post-menopau-sal women with early breast cancer from the Health Care system perspective in Egypt. METHODS: A Markov process model over 15-year time horizon with five health states (no recurrence, local or distant recurrence, contralateral breast cancer and death) based on the Egyptian clinical practice was developed. Transition probabilities were estimated based on the results from The Intergroup Exemestane Study (IES). Health effects were expressed in terms of quality adjusted life years (QALYS). Direct medical costs were obtained from the governmental hospitals in Egypt. All costs and effects were discounted at 3.5% annually according to the Egyptian pharmacoeconomic guidelines. Deterministic sensitivity analyses were conducted. RESULTS: The study revealed that Exemestane yielded an additional gain of 0.23 QALYs at lower cost estimated by EGP 24,976 than Tamoxifen over 15-years, Exemestane is the dominant therapy. Deterministic sensitivity analyses indicated that the transition probability between health states of no recurrence to distant metastasis for Exemestane arm had the greatest impact on the results. CONCLUSIONS: Exemestane 25mg is a cost saving strategy compared to Tamoxifen 20mg in post-menopausal women with early breast cancer.