The value-for-money of adjuvant aromatase inhibitors: time to put the debate to rest?

A prospective decision-impact study incorporating Breast Cancer Index into extended endocrine therapy decision-making

Aim: To prospectively assess the impact of gene expression-based assay Breast Cancer Index (BCI) on extended endocrine therapy (EET) decision-making. Patients & methods: The BCI-tested samples from primary tumors (Stage I–III, hormone receptor positive breast cancer, >3.5 year endocrine therapy). Patients and physicians completed questionnaires on EET preferences and decision conflict. Using these data, a fact-based economic model was developed to project the cost impact of BCI. Results: The BCI results affected treatment recommendations for 42/141 patients (overall mean, 62 year; 83% postmenopausal; 63% Stage I). Patient decision conflict decreased pre- to post-test. The BCI-related projected net savings (US$5190/patient) was robust under sensitivity analysis. Conclusion: Incorporating BCI into clinical practice meaningfully impacted physician EET recommendations and decreased patient decision conflict, with projected cost savings.

Endocrine therapy for breast cancer prevention in high-risk women: clinical and economic considerations

The global burden of breast cancer highlights the need for primary prevention strategies that demonstrate both favorable clinical benefit/risk profile and good value for money. Endocrine therapy with selective estrogen-receptor modulators (SERMs) or aromatase inhibitors (AIs) has been associated with a favorable clinical benefit/risk profile in the prevention of breast cancer in women at high risk of developing the disease. The available endocrine therapy strategies differ in terms of their relative reductions of breast cancer risk, potential side effects, and upfront drug acquisition costs, among others. This review highlights the clinical trials of SERMs and AIs for the primary prevention of breast cancer, and the cost-effectiveness /cost-utility studies that have examined their "value for money" in various health care jurisdictions.