PMID- 33558179 OWN - NLM STAT- MEDLINE DCOM- 20210728 LR - 20210728 IS - 1879-4076 (Electronic) IS - 1879-4068 (Linking) VI - 12 IP - 5 DP - 2021 Jun TI - Cost-effectiveness of endocrine therapy versus radiotherapy versus combined endocrine and radiotherapy for older women with early-stage breast cancer. PG - 741-748 LID - S1879-4068(21)00004-7 [pii] LID - 10.1016/j.jgo.2021.01.004 [doi] AB - PURPOSE: To evaluate the cost-effectiveness of endocrine therapy (ET), radiation therapy (XRT), and combination ET + XRT as post-surgical treatment for older women with early-stage breast cancer from the societal perspective. METHODS: We constructed a Markov state-transition model consisting of three mutually exclusive health-states: Disease-Free, Recurrence, or Death. Osteoporotic fracture, radiation-induced breast fibrosis, and radiation pneumonitis were modeled as treatment-related adverse events (AEs). Cancer registry-linked-Medicare data were used to assess probability of recurrence and total costs, after propensity adjustment to account for treatment selection, among women aged >65 years diagnosed with estrogen receptor positive or progesterone receptor positive (ER+/PR+) breast cancer receiving ET, XRT, or ET + XRT in 2007-2011. Following randomized controlled trials, overall survival was assumed equivalent, but locoregional recurrence varied. Indirect costs and health-state utilities were literature-driven and varied in sensitivity analyses. Costs and outcomes were discounted at 3% annually. RESULTS: In a cohort of 10,000 women over ten years, we estimated 1620 total recurrences in the ET-only group, 1296 in the XRT-only group, and 1076 with ET + XRT. Compared to ET-only, the base-case incremental cost-effectiveness ratio (ICER) was $10,826 per quality-adjusted life-year (QALY)-gained for XRT-only and $26,834/QALY-gained for ET + XRT. Similarities in cost and effectiveness between treatments led to highly sensitive results. We also present clinically-relevant patient preference scenarios for recurrence risk-averse patients and near-term AE risk-averse patients. CONCLUSIONS: The cost-effectiveness of regimens including ET and/or XRT in older women with early-stage breast cancer is sensitive to small differences in costs, as well as risk of, and utilities associated with, locoregional recurrence, suggesting that patient preferences concerning treatment benefits and risks should be considered by physicians. CI - Copyright (c) 2021 Elsevier Inc. All rights reserved. FAU - Wheeler, Stephanie B AU - Wheeler SB AD - Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA; Lineberger Comprehensive Cancer Center, UNC, USA. Electronic address: stephanie_wheeler@unc.edu. FAU - Rotter, Jason S AU - Rotter JS AD - Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA. FAU - Baggett, Christopher D AU - Baggett CD AD - Lineberger Comprehensive Cancer Center, UNC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, USA. FAU - Zhou, Xi AU - Zhou X AD - Lineberger Comprehensive Cancer Center, UNC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, USA. FAU - Zagar, Timothy AU - Zagar T AD - Department of Radiation Oncology, UNC School of Medicine, USA. FAU - Reeder-Hayes, Katherine E AU - Reeder-Hayes KE AD - Lineberger Comprehensive Cancer Center, UNC, USA; Division of Hematology/Oncology, UNC School of Medicine, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210206 PL - Netherlands TA - J Geriatr Oncol JT - Journal of geriatric oncology JID - 101534770 SB - IM MH - Aged MH - *Breast Neoplasms/drug therapy MH - Cost-Benefit Analysis MH - Female MH - Humans MH - Medicare MH - Neoplasm Recurrence, Local MH - Quality-Adjusted Life Years MH - United States OTO - NOTNLM OT - Breast cancer OT - Cost-effectiveness OT - Endocrine therapy OT - Geriatric oncology OT - Radiation therapy COIS- Declaration of Competing Interest SBW received unrelated grant funding to her institution from Pfizer. JR is currently employed by Mathematica, Inc.; his work on this manuscript was done as an employee of UNC Chapel Hill. EDAT- 2021/02/10 06:00 MHDA- 2021/07/29 06:00 CRDT- 2021/02/09 05:59 PHST- 2020/08/25 00:00 [received] PHST- 2020/11/25 00:00 [revised] PHST- 2021/01/12 00:00 [accepted] PHST- 2021/02/10 06:00 [pubmed] PHST- 2021/07/29 06:00 [medline] PHST- 2021/02/09 05:59 [entrez] AID - S1879-4068(21)00004-7 [pii] AID - 10.1016/j.jgo.2021.01.004 [doi] PST - ppublish SO - J Geriatr Oncol. 2021 Jun;12(5):741-748. doi: 10.1016/j.jgo.2021.01.004. Epub 2021 Feb 6.