The value of high adherence to tamoxifen in women with breast cancer: A community-based cohort study

C. McCowan, S. Wang, A. M. Thompson, B. Makubate, D. J. Petrie

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background:Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence.Methods:We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80%.Results:A total of 354 (28%) patients had a recorded recurrence and 504 (39%) died. Four hundred and seventy-five (38%) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52% (P<0.001). Time to other cause mortality was also reduced by 23% (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95% CI: 1.15-1.71) discounted life years or 1.12 (95% CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95% CI: £4644-£7372). Assuming a willingness to pay threshold of £25 000 per QALY, the expected value of changing a patient from low to high adherence is £33 897 (95% CI: £28 322-£39 652).Conclusion:Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.

Original languageEnglish
Pages (from-to)1172-1180
Number of pages9
JournalBritish Journal of Cancer
Volume109
Issue number5
DOIs
Publication statusPublished - Sep 1 2013

Fingerprint

Tamoxifen
Cohort Studies
Breast Neoplasms
Costs and Cost Analysis
Recurrence
Quality-Adjusted Life Years
Cost-Benefit Analysis
Quality of Life
Clinical Audit
Cancer Care Facilities
Death Certificates
Hospital Records
Scotland
Registries
Weights and Measures
Mortality
Health
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Oncology

Cite this

McCowan, C. ; Wang, S. ; Thompson, A. M. ; Makubate, B. ; Petrie, D. J. / The value of high adherence to tamoxifen in women with breast cancer : A community-based cohort study. In: British Journal of Cancer. 2013 ; Vol. 109, No. 5. pp. 1172-1180.
@article{18a1d2eb49d34e998251221a1ef3b698,
title = "The value of high adherence to tamoxifen in women with breast cancer: A community-based cohort study",
abstract = "Background:Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence.Methods:We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80{\%}.Results:A total of 354 (28{\%}) patients had a recorded recurrence and 504 (39{\%}) died. Four hundred and seventy-five (38{\%}) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52{\%} (P<0.001). Time to other cause mortality was also reduced by 23{\%} (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95{\%} CI: 1.15-1.71) discounted life years or 1.12 (95{\%} CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95{\%} CI: £4644-£7372). Assuming a willingness to pay threshold of £25 000 per QALY, the expected value of changing a patient from low to high adherence is £33 897 (95{\%} CI: £28 322-£39 652).Conclusion:Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.",
author = "C. McCowan and S. Wang and Thompson, {A. M.} and B. Makubate and Petrie, {D. J.}",
year = "2013",
month = "9",
day = "1",
doi = "10.1038/bjc.2013.464",
language = "English",
volume = "109",
pages = "1172--1180",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "5",

}

The value of high adherence to tamoxifen in women with breast cancer : A community-based cohort study. / McCowan, C.; Wang, S.; Thompson, A. M.; Makubate, B.; Petrie, D. J.

In: British Journal of Cancer, Vol. 109, No. 5, 01.09.2013, p. 1172-1180.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The value of high adherence to tamoxifen in women with breast cancer

T2 - A community-based cohort study

AU - McCowan, C.

AU - Wang, S.

AU - Thompson, A. M.

AU - Makubate, B.

AU - Petrie, D. J.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background:Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence.Methods:We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80%.Results:A total of 354 (28%) patients had a recorded recurrence and 504 (39%) died. Four hundred and seventy-five (38%) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52% (P<0.001). Time to other cause mortality was also reduced by 23% (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95% CI: 1.15-1.71) discounted life years or 1.12 (95% CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95% CI: £4644-£7372). Assuming a willingness to pay threshold of £25 000 per QALY, the expected value of changing a patient from low to high adherence is £33 897 (95% CI: £28 322-£39 652).Conclusion:Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.

AB - Background:Low adherence to adjuvant tamoxifen is associated with worse health outcomes but little is known about the cost-effectiveness of high adherence.Methods:We conducted an economic evaluation using data for all women with incident breast cancer between 1993 and 2000 who were subsequently prescribed tamoxifen in the Tayside region of Scotland. Patient-level, lifetime Markov models evaluated the impact of high vs low adherence to tamoxifen using linked prescribing, cancer registry, clinical cancer audit, hospital discharge and death records. Direct medical costs were estimated for each patient and quality-of-life weights were assigned. Recurrence information was collected by case note review and adherence calculated from prescribing records with low adherence classed below 80%.Results:A total of 354 (28%) patients had a recorded recurrence and 504 (39%) died. Four hundred and seventy-five (38%) patients had low adherence over the treatment period, which was associated with reduced time to recurrence of 52% (P<0.001). Time to other cause mortality was also reduced by 23% (P=0.055) but this was not statistically significant. For an average patient over her lifetime, low adherence was associated with a loss of 1.43 (95% CI: 1.15-1.71) discounted life years or 1.12 (95% CI: 0.91-1.34) discounted quality-adjusted life years (QALYs) and increased discounted medical costs of £5970 (95% CI: £4644-£7372). Assuming a willingness to pay threshold of £25 000 per QALY, the expected value of changing a patient from low to high adherence is £33 897 (95% CI: £28 322-£39 652).Conclusion:Patients with low adherence have shorter time to recurrence, increased medical costs and worse quality of life. Interventions that encourage patients to continue taking their treatment on a daily basis for the recommended 5-year period may be highly cost-effective.

UR - http://www.scopus.com/inward/record.url?scp=84883740983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883740983&partnerID=8YFLogxK

U2 - 10.1038/bjc.2013.464

DO - 10.1038/bjc.2013.464

M3 - Article

C2 - 23949153

AN - SCOPUS:84883740983

VL - 109

SP - 1172

EP - 1180

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 5

ER -