Clinical and Economic Benefits of Aromatase Inhibitor Therapy in Early-stage Breast Cancer

Stefan Glück; Fariborz Gorouhi

Am J Health Syst Pharm. 2011;68(18):1699-1706.

Conclusion

AI therapy has become a standard of care for the treatment of most postmenopausal women with early-stage breast cancer. Emerging data have demonstrated potential overall survival advantages for AIs subsequent to and directly related to distant recurrence. When the economic burden to society is considered, it appears that all AIs are similarly beneficial on the basis of disease recurrence.

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Dr. Glück has received research support from Novartis and Pfizer and is an advisor and speaker for Novartis, Pfizer, and AstraZeneca. Dr. Gorouhi has declared no potential conflicts of interest.

Cite this: Clinical and Economic Benefits of Aromatase Inhibitor Therapy in Early-stage Breast Cancer - Medscape - Sep 15, 2011.

Table 1. Disease-Free Survival in Clinical Trials Comparing Aromatase Inhibitor Therapy With Tamoxifen Monotherapy
Trial^a	Median Follow-up Time (mo)	No. Disease-Free Patients at Follow-up		Hazard Ratio (95% CI)	p
Trial^a	Median Follow-up Time (mo)	Aromatase Inhibitor	Tamoxifen	Hazard Ratio (95% CI)	p
Monotherapy
TEAM²³	33	4898	4868	0.89 (0.77–1.03)	0.12
TEAM (on study drug)²³	33	4853	4817	0.83 (0.71–0.97)	0.02
ATAC²⁴	33.3	3092	3094	0.83 (0.71–0.96)	0.013
ATAC²⁵	68	3092	3094	0.87 (0.78–0.97)	0.01
ATAC¹⁰	100	3092	3,094	0.90 (0.82–0.99)	0.025
BIG 1–98²⁶	25.8	4003	4007	0.81 (0.70–0.93)	0.0003
BIG 1–98¹²	76	2463	2459	0.88 (0.78–0.99)	0.03
Sequential therapy
IES²⁷	30.6	2362	2380	0.68 (0.56–0.82)	<0.001
IES⁹	55.7	2352	2372	0.76 (0.66–0.88)	0.0001
ABCSG 8/ARNO 95¹¹	28	1618	1606	0.60 (0.44–0.81)	0.0009

^aTEAM = Tamoxifen Exemestane Adjuvant Multinational trial, ATAC = Arimidex, Tamoxifen, Alone or in Combination trial, BIG 1–98 = Breast International Group 1–98 trial, IES = Intergroup Exemestane Study, ABCSG 8 = Austrian Breast and Colorectal Cancer Study Group 8, ARNO 95 = Arimidex-Nolvadex 95 trial, CI = confidence interval.

Table 2. Estimated Costs of Recurrences Utilized in Economic Analyses
Recurrence	Cost of Recurrence by Trial (Trial Location)^a
Recurrence	IES (Canada)34	ATAC (United Kingdom) ^35,b	BIG 1–98 (United States)36	BIG 1–98 (Canada)37
Local recurrence	…^c	…	$25,892	$7,193
Diagnosis and staging	$263	$1,260	…	…
Physician visit(s)	$177	…	…	…
Surgery and treatment	$4,232	$4,065	…	…
Chemotherapy	$7,972	…	…	…
Follow-up	…	$223	…	…
Contralateral recurrence	…	…	$20,308	$10,009
Diagnosis and staging	$263	$1,260	…	…
Physician visit(s)	$177	…	…	…
Surgery and treatment	$7,965–$8,380	…	…	…
Chemotherapy	$7,972	…	…	…
Distant recurrence	…	…	$47,392	$5,704
Diagnosis and restaging	$1,054	$1,260	…	…
Physician visit(s)	$531	…	…	…
Pharmacologic therapy	$10,409	$5,558	…	…
Chemotherapy	$9,363	…	…	…
Diagnosis and restaging for progression	$721
Palliative care	$4,844	$310	…	…
Second primary nonbreast cancer	…	…	…	…
Initial diagnosis and treatment	$18,060	…	…	…
Follow-up	$2,427	…	…	…
Death	…	…	…	…
From breast cancer	$20,139	$5,901	$4,983	$18,925
From other causes	$5,743	$780	…	…

^aIES = Intergroup Exemestane Study, ATAC = Arimidex, Tamoxifen, Alone or in Combination trial, BIG 1–98 = Breast International Group 1–98 trial.
^b Converted at the equivalent of £1.00 = $1.56 (http://finance.yahoo.com/currency-converter exchange rate on December 1, 2010).
^c Not reported.

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