Half-Dose Fulvestrant plus Anastrozole as a First-Line Treatment for Hormone Receptor-Positive Metastatic Breast Cancer: A Cost-Effectiveness Analysis

Abstract Objective The S0226 trial demonstrated that the combination of
half-dose fulvestrant (FUL) and anastrozole (ANA) (F&A) caused a
significant improvement in overall survival (OS) versus ANA monotherapy
for first-line treatment of postmenopausal women with hormone
receptor-positive metastatic breast cancer (PMW-MBC[HR+]). The objective
of this study was to evaluate the cost-effectiveness of F&A in the
first-line treatment for PMW-MBC(HR+) in China. Design We constructed a
Markov model over a life-time horizon. The clinical outcomes and utility
data were obtained from published literature. Cost data were obtained from
official Chinese websites. Sensitivity analyses were performed to test
result uncertainty. Setting Chinese health care system perspective.
Population A hypothetical cohort of adult patients presenting with
PMW-MBC(HR+). Interventions F&A compared with full-dose FUL and
ANA monotherapy. Main outcome measures The main outcome of this study was
the incremental cost-effectiveness ratio (ICER) and quality-adjusted
life-years (QALY). Results ANA was estimated to have the lowest cost and
minimum life years (LYs). The ICER of F&A versus ANA was
$15,665.891/QALY with incremental cost and QALY of $12,401.120 and 0.792,
respectively, which was less than the willingness-to-pay (WTP) of
$29,383/QALY. Compared with F&A, FUL yielded a higher cost and a
shorter lifetime; hence, it was identified as a dominated strategy. The
univariate sensitivity analysis indicated the price of FUL was the most
influential factor in our study. The probability that F&A was
cost-effective at a threshold of $29,383/QALY in China was 86.5%.
Conclusion F&A is a cost-effective alternative to FUL and ANA
monotherapy for the first-line treatment of PMW-MBC(HR+) in China.
F&A is a promising first-line treatment for PMW-MBC(HR+), and more
research is needed to evaluate the economy of using F&A in other
countries.