ArticleHealth economics review2025
Primary endocrine therapy versus surgery plus endocrine therapy for early-stage breast cancer in older women without frailty: a cost-effectiveness and value of implementation analysis.
Article in Health economics review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
backgroundClinical guidelines recommend surgery for early-stage breast cancer in operable patients; however, primary endocrine therapy (PET) is often used in older women aged ≥ 70. This study aimed to estimate the cost-effectiveness and value of implementation of surgery plus adjuvant endocrine therapy (ET) compared with PET for older women with early breast cancer who are fit for surgery.
methodA partitioned survival analysis model was developed using effectiveness data from the published literature (time horizon: lifetime). Health outcomes were measured as quality-adjusted life years (QALYs; EQ-5D-3L UK tariff). Direct costs were estimated from the perspective of NHS England (discount rate: 3.5%). Probabilistic sensitivity analysis and value of implementation analysis were conducted using a cost-effectiveness threshold of £20,000-£30,000 per QALY gained.
resultsSurgery + ET resulted in higher QALYs (4.57) compared to PET (3.87) and higher costs (£10,628 vs. £6,102). The incremental cost-effectiveness ratio (ICER) was £6,412.62 per QALY gained, indicating that surgery + ET is cost-effective compared to PET. The value of implementation analysis showed that imperfect implementation of surgery + ET resulted in a loss of 0.12 QALYs per patient, equating to 9,267 QALYs at the population level.
conclusionSurgery with adjuvant ET is a clinically effective and cost-effective strategy compared with PET for older women with ER + operable early-stage breast cancer. Strengthening adherence to national guidelines will improve population health outcomes and healthcare resource use. Future economic evaluations should focus on the value of management strategies for older patients unfit for surgery due to frailty or comorbidities.
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