Cost-effectiveness of full coverage of aromatase inhibitors for Medicare beneficiaries with early breast cancer

Diverse mechanisms of action have been proposed for the immunologic effects of estrogen, including altered wound healing and disruption of neutrophil function. Keloidal fibroblasts may also function via a hormonally mediated mechanism; thus, dysregulated estrogen levels may result in adverse effects on cutaneous wound healing (Meade et al., 2015). Of note, patients who develop immune-mediated dAEs while on an AI may be able to tolerate other AIs.

The characteristics of identified studies have been briefly summarised in tables. It is the intention of the review authors that a new search for RCTs will be performed and the review will be updated every two years. All claims expressed in this article are solely those of the authorsand do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission.

• Your first step should be to talk to your healthcare provider and ask about generic options.
• The third-generation AIs are a welcome additional option for the endocrine therapy of hormone receptor-positive breast cancer in postmenopausal women.
• Bone mineral density rapidly decreases resulting in increased risk of skeletal fragility.
• Our critique of these analyses in light of best practices for assessing uncertainty raises concerns about validity and signals that the ICERs and ICURs may be underestimates of the cost-effectiveness of aromatase inhibitors for women with early stage breast cancer.
• The introduction of AI during the last decade has opened new horizons in the successful treatment of hormone receptor positive breast cancer.
• MF, DC, LH extract data and use the help of (CFG) in extracting the 2 articles in Spanish.

Oral Tablet

The CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib are used in combination with hormone therapy to treat some hormone receptor-positive metastatic breast cancers. The costs included in this model were based only on direct medical costs obtained directly from the HMC formulary for the medications, and from the HMC Department of Accounting and Finance for the related costs. All costs were based on the 2022–2023 financial year and were put into the model in the local currency of QAR. The first component of the direct medical costs was based on the drug acquisition cost for each of the treatment arms generated by the unit dose cost multiplied by the number of days consumed for each of the medication components. The hospitalization costs were also estimated and included in the cost calculations of the model.

Although that study has used a similar model input source, we noticed that their ribociclib cost was the lowest followed by abemaciclib followed by ribociclib, with ribociclib 20% less than abemaciclib (44). Therefore, we reason that the difference in conclusion to the different drug costs between our settings and theirs. The second study was conducted in the USA; however, it was published only in an abstract form which prevented us from digging deeper to investigate the reasons for the difference in conclusions (45). Lastly, our study showed that palbociclib was not also a cost-effective option compared to abemaciclib.

Hormone receptor status and hormone therapy

These agents include MEK inhibitors, Raf inhibitors, PI3K inhibitors, mTOR inhibitors, and Akt inhibitors. However, future studies are still needed to determine the strategy to prolong or avert the AI resistance. Furthermore, obtaining the tumor specimens when it is feasible in the patients with AI resistance is also critical. Global gene expression analysis of these biopsied specimens would allow us to have a better insight to the mechanisms underlying AI resistance. More than 3.8 million women in the United States have a history of breast cancer (BC; Biglia et al., 2015; Ferreira et al., 2019; Kharb et al., 2020; Sussman et al., 2019).

The benefits of endocrine therapy with AIs versus TAM in this patient setting have been solidly demonstrated in the literature (28), and other attempts to confirm these findings have led to the publication of different trials focusing on the superiority of AIs over TAM. The BIG 1-98 trial (18, 35–40) is a four-arm, phase III, double-blind, randomized trial comparing adjuvant letrozole versus TAM administered for 5 years in postmenopausal patients. This study was designed to describe these two drug sequences (2 years of one treatment followed by 3 years of the other). The primary endpoint was DFS; in contrast, the other endpoints included OS, DRFI, and invasive BCFI. The authors also examined breast cancer mortality and provided split analyses for monotherapy comparisons (letrozole vs. TAM) and sequential therapy comparisons versus TAM monotherapy.

Generic drugs are usually sold for lower prices than their branded equivalents, because competition increases among producers when drugs no longer are protected by patents (3,4). First, this review included only fully published studies, and we did not look at grey literature and excluded conference abstracts. Second, most of the studies adopted the health care system perspective rather than the societal perspective, which limits the generalizability of results.

The oncologist is the physician who prescribes AI and follows the patient over time. Therefore, he plays a crucial role in the prevention of the side-effects of using the drug. Additional sources of prior knowledge and expectations included medical professionals in their families or group of acquaintances, and societal knowledge from the media such as magazines, television, and movies that contributed to a baseline societal knowledge. Knowledge gleaned from societal sources was often either not accurate or not appropriate for the woman’s own specific diagnosis or treatment plan.

Twelve studies performed sensitivity analysis on the risk of adverse events and 7 assumed no additional mortality risk with any adverse event. Sub-group analysis was limited; 6 studies examined older women, 2 examined women with low recurrence risk, and 1 examined women with multiple comorbidities. Historically, patients with ER-positive breast cancer treated with TAM for 5 years had a decreased risk of death by approximately half during pharmacological treatment. AIs impede Oral steroids buy the conversion of androgens to estrogens; therefore, they cannot be adopted in premenopausal women unless they are exposed to ovarian function suppression (OFS) (17).

Benefits of hormone therapies in early and locally advanced breast cancer treatment

Conceptualization, DG; writing, original draft preparation, Ethos srl.; writing, review, and editing, Ethos srl; supervision, DG. All the authors have read, reviewed, and agreed to the published version of the manuscript. ADue to the heterogeneity between studies, this pooled value was from the random-effects analysis, while others were from the fixed-effect analysis. It’s recommended you have a dental exam (along with any dental work that needs to be done) before you start treatment with a bisphosphonate or denosumab 10. Before getting any dental procedure while on bone-strengthening therapy, talk with your oncologist. Bone density can be checked about every 2 years while taking an aromatase inhibitor.