Cost-Effectiveness Modeling of Surgery Plus Adjuvant Endocrine Therapy Versus Primary Endocrine Therapy Alone in UK Women Aged 70 and Over With Early Breast Cancer

Holmes, Geoffrey R.; Ward, Sue E.; Brennan, Alan; Bradburn, Michael; Morgan, Jenna L.; Reed, Malcolm W.R.; Richards, Paul; Rafia, Rachid; Wyld, Lynda; Burton, Maria; Lifford, Kate; Edwards, Adrian; Walters, Stephen; Ring, Alistair; Robinson, Thompson; Martin, Charlene; Chater, Tim; Pemberton, Kirsty; Cheung, Kwok Leung; Todd, Annaliza; Brain, Kate; Audisio, Riccardo A.; Wright, Juliette; Simcock, Richard; Thomson, Alistair; Gosney, Margot; Hatton, Matthew; Green, Tracy; Revill, Deirdre; Gath, Jacqui

Abstract

Objectives: Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET for women with varying health and fitness, identifying subgroups for which each treatment is cost-effective. Methods: Survival outcomes from a statistical model, and published data on recurrence, were combined with data from a large, multicenter, prospective cohort study of over 3400 UK women aged 70+ with early breast cancer and median 52-month follow-up, to populate a probabilistic economic model. This model evaluated the cost-effectiveness of surgery plus adjuvant therapies relative to PET for 24 illustrative subgroups: Age {70, 80, 90} × Nodal status {FALSE (F), TRUE (T)} × Comorbidity score {0, 1, 2, 3+}. Results: For a 70-year-old with no lymph node involvement and no comorbidities (70, F, 0), surgery plus adjuvant therapies was cheaper and more effective than PET. For other subgroups, surgery plus adjuvant therapies was more effective but more expensive. Surgery plus adjuvant therapies was not cost-effective for 4 of the 24 subgroups: (90, F, 2), (90, F, 3), (90, T, 2), (90, T, 3). Conclusion: From a UK perspective, surgery plus adjuvant therapies is clinically effective and cost-effective for most women aged 70+ with early breast cancer. Cost-effectiveness reduces with age and comorbidities, and for women over 90 with multiple comorbidities, there is little cost benefit and a negative impact on quality of life.

Citation

Holmes, G. R., Ward, S. E., Brennan, A., Bradburn, M., Morgan, J. L., Reed, M. W., Richards, P., Rafia, R., Wyld, L., Burton, M., Lifford, K., Edwards, A., Walters, S., Ring, A., Robinson, T., Martin, C., Chater, T., Pemberton, K., Cheung, K. L., Todd, A., …Gath, J. (2021). Cost-Effectiveness Modeling of Surgery Plus Adjuvant Endocrine Therapy Versus Primary Endocrine Therapy Alone in UK Women Aged 70 and Over With Early Breast Cancer. Value in Health, 24(6), 770-779. https://doi.org/10.1016/j.jval.2020.12.016

• Journal Article Type: Article
• Acceptance Date: Dec 2, 2020
• Online Publication Date: Apr 15, 2021
• Publication Date: 2021-06
• Deposit Date: Jun 25, 2021
• Publicly Available Date: Apr 16, 2022
• Journal: Value in Health
• Print ISSN: 1098-3015
• Electronic ISSN: 1524-4733
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 6
• Pages: 770-779
• DOI: https://doi.org/10.1016/j.jval.2020.12.016
• Keywords: Public Health, Environmental and Occupational Health; Health Policy
• Public URL: https://nottingham-repository.worktribe.com/output/5723407
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1098301521000966#!
• Additional Information: Authors and the Age Gap Trial Steering Group.