[A cost-effectiveness study of first-line hormone therapy in post-menopausal patients with metastatic breast cancer on neoadjuvant treatment].

Objective: Breast cancer is a hormone-dependent tumor, which expands therapy options. The aim of this study was to perform a pharmacoeconomic assessment of these drugs in post-menopausal patients with metastatic breast cancer or on neoadjuvant therapy.

Method: To assess the efficacy of both drug classes a meta-analysis was carried out from papers obtained in a Medline literature search (1997 - June 2004) using the following keywords: breast cancer, postmenopausal, aromatase inhibitors, antiestrogens, tamoxifen, neoadjuvant. Effectiveness parameters included: objective response, percentage with conservative surgery in neoadjuvancy; in metastatic breast cancer, time to progression. Costs were considered from drug acquisition data. To determine result strength a sensitivity analysis was undertaken, with modified costs and effectiveness.

Results: Results show a higher effectiveness for aromatase inhibitors as compared to antiestrogens. In neoadjuvant therapy: 56.38% versus 36% for objective response rate, and 47.64% versus 35% for conservative surgery. In metastatic cancer: 9.96 versus 6.61 months for time to progression (p
Conclusions: Selecting an aromatase inhibitor is a valid option in neoadjuvancy, even if such selection would represent a very high cost for metastatic cancer.