Aromatase inhibitors in breast cancer: a review of cost considerations and cost effectiveness

Since adrenalectomy has also been used to treat breast cancer, Richard Santen and colleagues started to use aminoglutethimide as a “medical” adrenalectomy Steroids for breast cancer. In late 1970s, they were able to show that aminoglutethimide was effective in treating breast cancer 35. Subsequently, Santen demonstrated that the key beneficial effect of aminoglutethimide in fact was the inhibition of aromatase enzyme which resulted in the reduction of estrogens. Nevertheless, due to its inhibition of CYP11, cortisol replacement was also needed to be given in combination with aminoglutethimide.

Because of its short‐term follow‐up period, the current study provides no evidence to support the effectiveness of AIs in raising or lowering the odds of recurrence of uterine fibroids. Finally, because no study reported on economic evaluations, it is impossible to determine the cost‐effectiveness of AI treatment for women with uterine fibroids. Summary data were extracted from the included study, in which an aromatase inhibitor (letrozole) was administered orally (2.5 mg/d), regardless of the day of the menstrual period. In this study, all outcomes were measured at baseline and during treatment at 2, 4, 6 and 12 weeks after the start of treatment. Nevertheless, according to our review protocol, only measures obtained at week 12 were taken into account.

Dermatologists can improve patient QoL by aiding in the prevention, recognition, and management of dAEs (Woodford et al., 2019). We abstracted characteristics of the identified studies including publication year, country, comparators, outcomes (life years, QALYs, or both), model perspective, type of model, study sponsorship, time horizon and discount rate. DFS, disease-free survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; TAM, tamoxifen; AIs, aromatase inhibitors.

Table 2. Incidence of thromboembolic events with aromatase inhibitors and comparators.

Therefore, to support informed decision-making related to persistence on AHT by older breast cancer survivors of early-stage breast cancer, we aimed to explore women’s retrospections on their prior knowledge and expectations of treatments. The data are derived from a parent qualitative study where we examined how women 65 years and older received, interpreted, and made decisions to continue or prematurely stop an AI29. Given the increasing use of adjunctive AIs caused by the improved survival of breast cancer patients, it is expected that the disease burden of AF in these patients will likewise increase. Because AF can be asymptomatic, many patients may not be diagnosed until stroke occurs.23,24 Furthermore, the CHA2DS2-VASc score of breast cancer patients is generally high because they are women, are of relatively advanced age, and have cardiovascular comorbidities. It is therefore imperative to remain vigilant for subclinical AF among AI recipients and initiate appropriate anticoagulation therapies for stroke prevention.

It is appropriate to consider that abemaciclib, palbociclib and ribociclib have a class effect

• The data were derived from a parent study aimed to develop a descriptive framework of the decisional processes used to continue or prematurely stop an AI.
• These medications either stop estrogen from reaching the cancer cells, or they reduce the amount of estrogen that a woman’s body makes.
• It also noted that the overall-survival data are immature in 3 out of the 4 trials (final overall-survival data are available in PALOMA 1 only).
• 1, 2 Cost-effectiveness analysis (CEA) is recognized as an important tool for assessing value for money and an important source of information for making clinical and policy decisions.

It included data from four large trials, all designed with TAM administered in the control arm and different AIs (exemestane, anastrozole, and letrozole) administered in the experimental arm. Every trial was reviewed for the clinical benefit rate, duration of clinical benefit (DoCB), PFS, and OS. The authors observed that AIs enabled more patients to achieve clinical benefits (CB) than TAM. The DoCB appeared slightly higher for AIs but did not significantly differ from TAM.

When possible, we planned to extract data to allow an intention‐to‐treat analysis (this analysis includes all participants in the groups to which they were originally randomly assigned). If the numbers randomly assigned were inconsistent with the numbers analysed, we planned that the percentage loss to follow‐up would be calculated and reported in the Characteristics of Included Studies table. For continuous outcomes (e.g. fibroid size), we planned to extract the final value and the standard deviation of the outcomes of interest, as well as the number of women assessed at the endpoint in each treatment arm and at the end of follow‐up. In the case of outcomes with continuous data in different scales, we planned to use standardised mean differences (SMDs) with 95% CIs.