Tamoxifen for breast cancer risk reduction

Impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis

Joy Melnikow, Stephen Birch, Christina Slee, Theodore J. McCarthy, L. Jay Helms, Miriam Kuppermann

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life. OBJECTIVES: To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction. RESEARCH DESIGN: A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model. SUBJECTS: Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk ?1.67% participated in utility assessment interviews. MEASURES: Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use. RESULTS: Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances. CONCLUSIONS: CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.

Original languageEnglish (US)
Pages (from-to)946-953
Number of pages8
JournalMedical Care
Volume46
Issue number9
DOIs
StatePublished - Sep 2008

Fingerprint

Social Adjustment
Tamoxifen
Risk Reduction Behavior
Cost-Benefit Analysis
quality of life
cancer
Quality of Life
Breast Neoplasms
costs
Patient Preference
Health
health
Outcome Assessment (Health Care)
Interviews
Delivery of Health Care
inclusion
health care

Keywords

  • Breast cancer prevention
  • Costeffectiveness analysis
  • Quality-adjusted life year
  • Tamoxifen
  • Utilities

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Tamoxifen for breast cancer risk reduction : Impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis. / Melnikow, Joy; Birch, Stephen; Slee, Christina; McCarthy, Theodore J.; Helms, L. Jay; Kuppermann, Miriam.

In: Medical Care, Vol. 46, No. 9, 09.2008, p. 946-953.

Research output: Contribution to journalArticle

Melnikow, Joy ; Birch, Stephen ; Slee, Christina ; McCarthy, Theodore J. ; Helms, L. Jay ; Kuppermann, Miriam. / Tamoxifen for breast cancer risk reduction : Impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis. In: Medical Care. 2008 ; Vol. 46, No. 9. pp. 946-953.
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