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Cost-effectiveness of adjuvant endocrine treatment with tamoxifen for male breast cancer

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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.

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Data availability

All data generated or analyzed during this article are included in the published article (and in its supplementary information files).

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Acknowledgements

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Author notes

  1. Ya** Huang and Chengjie Ke contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350005, China

    Ya** Huang, Jiaqin Cai, **-Huang-Aff1">Ya** Huang

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  4. **aoxia Wei
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Contributions

YPH: conception and design, acquisition of data, analysis and interpretation of data, drafting of the article, final approval of the manuscript. CJK: conception and design, analysis and interpretation of data, revision of the article for critically important intellectual content, final approval of the manuscript. JQC: acquisition of data, analysis and interpretation of data, final approval of the manuscript. XXW: acquisition of data, final approval of the manuscript. MHC: acquisition of data, final approval of the manuscript. HS: conception and design, revision of the article for critically important intellectual content, final approval of the manuscript.

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Correspondence to Hong Sun.

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Supplementary Information

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12282_2024_1605_MOESM1_ESM.docx

Supplementary file1 Table S1 Goodness-of-fit of different survival functions (first model). Abbreviations: AIC, Akaike’s information criterion; BIC, Bayesian’s information criterion; DFS, disease-free survival; OS, overall survival; TAM, tamoxifen. Table S2 Goodness-of-fit of different survival functions (second model). Abbreviations: AIC, Akaike’s information criterion; BIC, Bayesian’s information criterion; DFS, disease-free survival; OS, overall survival; TAM, tamoxifen. Figure S1 The sensitivity analysis result of first model (Figure S1a) and second model (Figure S1b) in the USA. Abbreviations: BC, breast cancer; DFS, disease-free survival; PD, progression of disease; TAM, tamoxifen (DOCX 323 KB)

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Huang, Y., Ke, C., Cai, J. et al. Cost-effectiveness of adjuvant endocrine treatment with tamoxifen for male breast cancer. Breast Cancer (2024). https://doi.org/10.1007/s12282-024-01605-2

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