The value of high adherence to tamoxifen in women with breast cancer
Journal article
Authors/Editors
Research Areas
- Clinical medicine (MEDICAL AND HEALTH SCIENCES)
( - Andrology; Obstetrics and gynaecology; Paediatrics; Cardiac and Cardiovascular systems; Peripheral vascular disease; Hematology; Respiratory systems; Critical care medicine and Emergency medicine; Anaesthesiology; Orthopaedics; Surgery; Radiology, nuclear medicine and medical imaging; Transplantation; Dentistry, oral surgery and medicine; Dermatology and venereal diseases; Allergy; Rheumatology; Endocrinology and metabolism (including diabetes, hormones); Gastroenterology and hepatology; Urology and nephrology; Oncology; Ophthalmology; Otorhinolaryngology; Psychiatry; Clinical neurology; Geriatrics and gerontology; General and internal medicine; other clinical medicine subjects; Integrative and complementary medicine (alternative practice systems);
) - MEDICAL AND HEALTH SCIENCES (Frascati classification)
Publication Details
Subtitle: A community-based cohort study
Publisher: Springer Nature [academic journals on nature.com]: Hybrid Journals
Publication year: 2012
Journal: British Journal of Cancer (0007-0920)
Volume number: 109
Issue number: 5
End page: 1172
ISSN: 0007-0920
eISSN: 1532-1827
URL: https://www.nature.com/articles/bjc2013464
Languages: English-United States (EN-US)
Abstract
Background:Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence.Methods:We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80%.Results:A total of 354 (28%) patients had a recorded recurrence and 504 (39%) died. Four hundred and seventy-five (38%) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52% (P<0.001). Time to other cause mortality was also reduced by 23% (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95% CI: 1.15-1.71) discounted life years or 1.12 (95% CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95% CI: £4644-£7372). Assuming a willingness to pay threshold of £25 000 per QALY, the expected value of changing a patient from low to high adherence is £33 897 (95% CI: £28 322-£39 652).Conclusion:Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.
Keywords
No matching items found.
Documents
No matching items found.
