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.
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.
摘要：
背景：在ASCO指南中，他莫昔芬（TAM）被推荐为雌激素受体（ER）阳性早期乳腺癌患者的一线治疗方案。我们的研究旨在分析接受TAM辅助内分泌治疗与没有TAM相比的成本效益。并评估美国ER阳性早期男性乳腺癌患者高依从性TAM与低依从性的成本效益。
方法：构建了两个包含三个相互排斥的健康状况的马尔可夫模型：（1）第一个马尔可夫模型比较了添加TAM与不使用TAM的成本效益（TAM与不使用TAM）；（2）第二个模型比较了接受高依从性和低依从性的TAM（高依从性TAM与低依从性TAM）的成本效益。两种模型的模拟时间范围是患者的寿命。两个模型的有效性和安全性数据来自真实世界的研究。模型输入来自美国网站和已发布的文献。两个模型的主要结果都包括总成本，质量调整寿命年(QALYs)，和增量成本效益比(ICER)。
结果：在第一个模型中，与非TAM相比，TAM每QALY的ICER为5707.29美元，这大大低于美国每QALY50,000.00美元的WTP门槛。概率敏感性分析结果表明，该策略的成本效益概率为100.00%。在第二个模型中，与低依从性TAM相比，高依从性TAM绝对占主导地位。当WTP设置为$50,000.00/QALY时,高依从性TAM具有比低依从性TAM高99.70%的概率。所有这些参数在其合理范围内并没有反向改变我们模型的结果。
结论：我们的研究将为医师或患者在进行治疗决策时提供有价值的指导，并为决策时考虑将资金适当分配给这一特殊群体提供有效的参考。
方法：构建了两个包含三个相互排斥的健康状况的马尔可夫模型：（1）第一个马尔可夫模型比较了添加TAM与不使用TAM的成本效益（TAM与不使用TAM）；（2）第二个模型比较了接受高依从性和低依从性的TAM（高依从性TAM与低依从性TAM）的成本效益。两种模型的模拟时间范围是患者的寿命。两个模型的有效性和安全性数据来自真实世界的研究。模型输入来自美国网站和已发布的文献。两个模型的主要结果都包括总成本，质量调整寿命年(QALYs)，和增量成本效益比(ICER)。
结果：在第一个模型中，与非TAM相比，TAM每QALY的ICER为5707.29美元，这大大低于美国每QALY50,000.00美元的WTP门槛。概率敏感性分析结果表明，该策略的成本效益概率为100.00%。在第二个模型中，与低依从性TAM相比，高依从性TAM绝对占主导地位。当WTP设置为$50,000.00/QALY时,高依从性TAM具有比低依从性TAM高99.70%的概率。所有这些参数在其合理范围内并没有反向改变我们模型的结果。
结论：我们的研究将为医师或患者在进行治疗决策时提供有价值的指导，并为决策时考虑将资金适当分配给这一特殊群体提供有效的参考。
