Cost-effectiveness of letrozole in the treatment of advanced breast cancer.
Aromatase inhibitors are fast becoming the treatment of choice in the first-line management of hormone-sensitive patients with metastatic breast cancer, replacing tamoxifen. Although these agents appear to have clinical superiority, they are more expensive alternatives, thus requiring economic evaluation to consider their incremental value to the payer. This article reviews all published economic evaluations that compared aromatase inhibitors in the first- and second-line treatment setting. From the literature, seven separate evaluations were identified, which used different types of modeling techniques and considered the payer's perspective in three healthcare systems. The conclusion of these analyses was that letrozole (Femara, Novartis) is the most cost-effective intervention in the first-line setting, whilst being of similar cost-effectiveness to anastrozole (Arimidex, AstraZeneca) in the second-line setting. In addition, preliminary results suggest that letrozole is a cost-effective alternative in the extended adjuvant breast cancer treatment setting.