This economic evaluation was based on a decision model that simulated the development of disease under the two treatments. A time horizon of 60 months was considered. The authors stated that the perspective of the health care provider was adopted in the study.
The clinical data were derived from a pivotal randomised clinical trial (RCT), the Arimidex, Tamoxifen Alone or in Combination study, which followed postmenopausal women for a median time of 68 months and directly compared the two regimens. Other details of the trial were not reported. The key clinical measures were the rate of local, contralateral and distant relapse with AN or TAM.
Monetary benefit and utility valuations:
Measure of benefit:
The health outcomes were left disaggregated and no summary benefit measure was used. In effect, a cost-consequences analysis was performed. The key clinical estimates were the rates of success, failure and recurrence.
The analysis included the health services associated with drugs, clinical examination, mammography, pre-operative diagnostics and laboratory tests, surgery, hospital stay, outpatient unit, radiotherapy, chemotherapy, home care and transportation. A breakdown of the cost items was provided. Resource use was based on the medical charts of women diagnosed with primary early BC during 1997 to 2000 at the Institute of Oncology in Ljubljana. All medical costs came from the Institute of Oncology and other university and general hospitals. The drug costs came from a national official drug list. Non-medical costs were estimated from other national sources. The costs were in euros (EUR). The price year was not reported.
Analysis of uncertainty:
A multivariate sensitivity analysis was undertaken to address the issue of uncertainty. The prices of both drugs were varied. Worst- and best-case scenarios were then considered.