Economic evaluation of endocrine therapy in the treatment of breast cancer.

Endocrine therapy has become an integral part of the management of breast cancer and its different clinical applications raise different economic issues. The low toxicity, good response and relatively low cost of agents makes endocrine therapy an attractive treatment option for breast cancer patients at different stages of their disease. The method, hypotheses and expectations from economic analysis of endocrine therapy depend on the objectives of treatment (preventive, curative or palliative), the therapies being compared, the population being treated and the clinical benefits expected. The economic and quality of life literature has focused mainly on the analysis of endocrine therapy in the adjuvant setting. As budgets continue to shrink and treatment guidelines become challenged by new therapeutic and preventive approaches, decision analysis in breast cancer management is likely to become more explicit. Economic analysis can be a useful tool to guide clinical decisions in the management of this complex and chronic disease. Ultimately, the positioning of endocrine therapy with respect to other complementary or alternative treatment modalities will depend on the level of expected effectiveness, and on finding the best therapeutic solution to meet the breast cancer patient's clinical situation, expectations and needs.

[Cost of breast cancer screening]. / Le coût du dépistage du cancer du sein.

The adoption in France of a national breast cancer screening policy will depend in part on economic factors. These include the investments and costs of screening and the cost-effectiveness of screening as compared to other health interventions. There exist few economic data on breast cancer screening in France. Existing studies have estimated the cost of screening at 374 FF per woman screened, however they provide no indication of the cost-effectiveness of screening. The application of cost-effectiveness ratios obtained in other countries is difficult given the strong presence of spontaneous screening which is unique in France. Spontaneous screening may undermine the marginal gain in life expectancy expected from organized screening, however it does not offer the quality of organized screening in terms of systematic double reading and quality assurance of mammographic units. Precise and reliable data on the costs and effectiveness associated with both these forms of screening must be collected before reaching any conclusions on cost-effectiveness. These data will allow for the development of a coherent and equitable policy on screening in France which is justified both in economic terms and in terms of public health.