Tamoxifen for breast cancer risk reduction - Impact of alternative approaches to quality of life adjustment on cost effectiveness analysis

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    Abstract

    Background: In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life.

    Objectives: To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction.

    Research Design: A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model.

    Subjects: Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk ≥1.67% participated in utility assessment interviews.

    Measures: Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use.

    Results: Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances.

    Conclusions: CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.
    Original languageEnglish
    Title of host publicationhost publication
    Publication statusPublished - 2009
    EventInternational Conference on Health Policy - Jerusalem
    Duration: 8 Dec 200910 Dec 2009

    Conference

    ConferenceInternational Conference on Health Policy
    CityJerusalem
    Period8/12/0910/12/09

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