A randomised trial of tamoxifen versus tamoxifen with aminoglutethimide in post-menopausal women with advanced breast cancer

1985 ◽  
Vol 14 (3) ◽  
Author(s):  
R. Milsted ◽  
T. Habeshaw ◽  
S. Kaye ◽  
G. Sangster ◽  
F. Macbeth ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Randomised Trial ◽  
Advanced Breast ◽  
Menopausal Women ◽  
Post Menopausal

scholarly journals Cost-effectiveness Analysis of Ribociclib plus Letrozole versus Palbociclib plus Letrozole in the United Kingdom

10.36469/9725 ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 20-31 ◽  
Author(s):  
Gaurav Suri ◽  
David Chandiwana ◽  
Adam Lee ◽  
Rohit Mistry
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Advanced Breast Cancer ◽  
Cost Savings ◽  
Cost Effective ◽  
Advanced Breast ◽  
Lifetime Horizon ◽  
Menopausal Women ◽  
Post Menopausal ◽  
The Cost

Objective: To evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with hormone receptor positive (HR+) and human epidermal growth receptor 2 negative (HER2-) advanced breast cancer from a UK payer perspective. Methods: A cohort-based partitioned survival model was developed to evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with HR+/HER2- advanced breast cancer over a lifetime horizon. The analysis was carried out from a National Health Services and Personal Social Services perspective, and results are presented in incremental costs per quality adjusted life years. Clinical data from three randomized controlled trials (MONALEESA-2, PALOMA-1 and PALOMA-2 studies) were used, and supplemented with available real world evidence. Costs categories comprised of drug acquisition, medical management, and treatment of adverse events. Healthcare resource utilization data were identified from literature and unit costs sourced from secondary sources. Utility values were derived from MONALEESA-2 study and were supported with values identified from literature. Both deterministic and probabilistic analyses were carried out to assess uncertainty. Results: In the base case, treatment with ribociclib plus letrozole increased mean progression free survival (PFS) by 4.1 months and overall survival by 5.0 months compared to palbociclib plus letrozole. Further, treatment with ribociclib plus letrozole resulted in cost-savings of £8464 and incremental QALYs of 0.261, demonstrating that treatment with ribociclib plus letrozole is dominant to treatment with palbociclib plus letrozole. The probabilistic analysis also yielded mean cost-savings of £7914 and mean QALY gain of 0.273. At willingness-to-pay threshold of £30 000 per QALY, treatment with ribociclib plus letrozole had a 92% probability of being cost-effective compared to palbociclib and letrozole. Conclusions: The results of the analysis demonstrate that ribociclib plus letrozole treatment is both cost-saving and a cost-effective option amongst the available cyclin dependent kinase 4/6 inhibitors for the treatment of post-menopausal women with advanced breast cancer. The biggest driver of the cost savings were the lower acquisition costs of ribociclib.

DETERMINATION OF TAMOXIFEN AND AN HYDROXYLATED METABOLITE IN PLASMA FROM PATIENTS WITH ADVANCED BREAST CANCER USING GAS CHROMATOGRAPHY–MASS SPECTROMETRY

1979 ◽  
Vol 83 (3) ◽  
pp. 401-408 ◽  
Author(s):  
C. P. DANIEL ◽  
S. J. GASKELL ◽  
H. BISHOP ◽  
R. I. NICHOLSON
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Tamoxifen Therapy ◽  
Advanced Breast ◽  
Gas Chromatography Mass Spectrometry ◽  
Menopausal Women ◽  
Considerable Excess ◽  
Post Menopausal ◽  
Hydroxylated Metabolite

An assay has been established for the selective measurement of tamoxifen and its monohydroxy derivative, metabolite B, in human plasma. The assay was used to examine the concentrations of these compounds, relative to oestradiol-17β, in the plasma of patients undergoing tamoxifen therapy for advanced breast cancer. Oral administration of the drug (20 mg twice a day) raised the level of tamoxifen in plasma to approximately 200 ng/ml 20 days after the commencement of treatment. This level was 3000-fold higher than the corresponding concentration of oestradiol which remained within the range for post-menopausal women. Metabolite B was present in plasma at a much lower concentration than tamoxifen although in considerable excess over oestradiol. The overall results are discussed in relation to the possible mechanism of action of the drug.

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