OBJECTIVES:

Breast cancer (BC) is the second most common type of cancer worldwide and the most frequent cancer among women (approx. 25%) according to WHO. Globally, 1.67 million new BC cases were diagnosed in 2012, with an increased incidence after menopause.

Since most BC subtypes are hormone-related, national comprehensive cancer network (NCCN)-2017 guidelines recommended the use of third-generation anti-estrogen aromatase-inhibitor endocrine therapy in early-stage post-menopausal women having hormone receptor-positive BC. The aromatase-inhibitors; Anastrozole, Letrozole, and Exemestane lower the risk of BC recurrence and metastasis when used as initial first-line adjuvant therapy in addition to tamoxifen. Those drugs have shown similar anti-tumor efficacy and toxicity profiles in randomized studies in adjuvant and preoperative settings, rendering them equivalent choices for the management of BC.

Thus, this study aimed at performing cost minimization analysis for Anastrozole, versus Letrozole and Exemestane as a 5-year initial adjuvant therapy for the management of post-menopausal BC from patient's perspective in Egypt.

METHODS:

Direct medical costs are reported in Egyptian pounds (EGP) (1 USD=18.14 EGP). The single daily doses for Anastrozole, Letrozole, and Exemestane tablets are 1 mg, 2.5 mg, and 25 mg, respectively. Discounting was conducted for a treatment course of 5 years. One-way sensitivity analysis was performed where costs were varied with a range of ± 25%.

RESULTS:

Total costs for Anastrozole, Letrozole, and Exemestane were EGP18,071, EGP19,993, and EGP36,910, respectively. Thus, Anastrozole is the least expensive drug when compared to Letrozole and Exemestane for the management of BC. Sensitivity analysis showed that the study was insensitive to change using a range of ±25% in drugs’ costs.

CONCLUSIONS:

Anastrozole, Letrozole, and Exemestane are equivalent choices as adjuvant therapies in post-menopausal breast cancer patients. Therefore, having the lowest cost, Anastrozole is the most preferred option when compared to Letrozole, and Exemestane for the management of breast cancer from patient's perspective.