Table 2

Parameter estimates and sources
Variables Pre-menopausal Women Post-menopausal Women Duration Distribution used in PSA† Source
Base case value Range tested in sensitivity analyses Base case value Range tested in sensitivity analyses
Risk classification by CCP (%)
High risk 21.1 15.8 32.6 22.3 18 27 Dirichlet MCR
Chemotherapy-treated women 100 85.1 100 53.8 43 – 64.4 Beta MCR and PC
Intermediate risk 72.6 62.9 80.6 52.3 47 57.5 Dirichlet MCR
Chemotherapy-treated women 65.2 53.4 75.4 14.2 9.9 – 20 Beta MCR and PC
Low risk 6.3 0 – 10 25.4 21.2 30.2 Dirichlet MCR
Chemotherapy-treated women 16.7 10 – 20 3.4 0 – 10 Beta MCR and PC
Overall chemotherapy-treated women by CCP (%) 69 60 83 19 13 – 27.7 MCR and PC
Risk classification by RS-assay (%)
High risk 27.7 22.9– 33.1 23.1 18.7 – 28.3 Dirichlet [9]
Chemotherapy-treated women 100 90 – 100 100 90 – 100 Beta [9]
Intermediate risk 19.5 15.4 – 24.4 21.5 17.1 – 26.5 Dirichlet [9]
Chemotherapy-treated women 50 0 – 100 50 0 – 100 Beta [22,39,40,65]
Low risk 52.6 46.9 – 58.3 55.4 49.7 – 61 Dirichlet [9]
Chemotherapy-treated women 0 0 – 10 0 0 – 10 Beta [9]
Overall chemotherapy-treated women by RS-assay (%) 37.5 30 – 47.8 33.8 27 – 44.3 [9,22,39,40,65]
Chemotherapy-related serious adverse effects (%) 2.5 0 – 10.6 4 0 – 12.3 Beta MCR and HA
Health-State Utilities‡
Remission state
Remission on chemotherapy regimen with
Minor or no toxicity 0.85 −20% 0.783 −20% 6 months Beta [51,52,55]
Remission on chemotherapy regimen with
Major toxicity 0.623 −20% 0.577 −20% 6 months Beta [51,52,55]
Remission after chemotherapy regimen 0.872 −20% 0.808 −20% Life Beta [51,54]
Remission on hormonal therapy 0.881 −10% – +10% 0.816 −10% – +10% 60 months Beta [51,52,55]
Remission after hormonal therapy 0.89 −10% – +10% 0.824 −10% – +10% Life Beta [51,52,55]
Loco-regional recurrence, under treatment 0.623 −10% – +10% 0.577 −10% – +10% 12 month Beta [41,51,52,55]
Loco-regional recurrence, after treatment 0.757 −10% – +10% 0.700 −10% – +10% Life time Beta [41,51,52,55]
Distant recurrence 0.445 −10% – +10% 0.412 −10% – +10% Life time Beta [41,51,52,55]
Death state 0 0
Cost associated with remission (per month), $
First year after diagnosis with ESBC
Cost of surgerya 3390 3000 – 3780 3642 3384 – 3900 One time LogNormal PC, HA and CL
Cost of radiation therapyb 3410 2737 – 4252 3027 2430 – 3776 One time LogNormal PC and CL
Cost of endocrine therapyc
Tamoxifen 12.4 11.6 – 13.2 12.4 11.6 – 13.2 12 months LogNormal DPIN
Aromatase inhibitors 156 120 193 12 months LogNormal DPIN
Aromatase + tamoxifen 72 62 81 12 months LogNormal DPIN
Cost of chemotherapyd
Nursing, overhead and administration costs 317.6 317.6 During chemotherapy LogNormal CL
Related physician costs 23.4 21.5 – 25.2 23.4 21.5 – 25.2 During chemotherapy LogNormal PC
Chemotherapy regimen options
CMF 478 823 5 months LogNormal MCR
AC 806 1918 3 months LogNormal MCR
FAC 924 1270 5 months LogNormal MCR
TAC 2455 2800 5 months LogNormal MCR
Weighted average cost of chemotherapy regimense 5 months LogNormal MCR
First three months on chemotherapy 1142 1099 3 months LogNormal MCR
Next 419 432 2 months LogNormal MCR
Cost of CSAEf 1263 978 – 1581 1,750 1376-2168 During chemotherapy LogNormal PC, HA and CL
Surveillanceg
Low risk 79 47 111 74 62 85 12 months LogNormal PC
Intermediate risk 93 76 108 66 60 68 12 months LogNormal PC
High risk 106 78 133 77 69 82 12 months LogNormal PC
After first year of diagnosis with ESBC
Cost of endocrine therapyc
Tamoxifen 12.4 11.6 – 13.2 12.4 11.6 – 13.2 48 months LogNormal DPIN
Aromatase inhibitors 156 120 193 48 months LogNormal DPIN
Aromatase + tamoxifen 72 62 81 48 months LogNormal DPIN
Surveillanceg
Low risk 39 18 59 33 30 54 Life time LogNormal PC
Intermediate risk 35 32 40 45 38 53 Life time LogNormal PC
High risk 102 65 126 39 32 45 Life time LogNormal PC
Cost associated with LR (per month), $
First year after LR
Cost of surgerya 3522 889 – 7280 2806 1068 – 3111 One time LogNormal PC, HA and CL
Cost of radiation therapyb 1098 878 – 1371 2120 1695 – 2651 One time LogNormal PC, HA and CL
Cost of endocrine therapyc
Tamoxifen 12.4 11.6 – 13.2 12.4 11.6 – 13.2 12 months LogNormal DPIN
Aromatase inhibitors 156 120 193 12 months LogNormal DPIN
Sequential aromatase → tamoxifen 72 62 81 12 months LogNormal DPIN
Cost chemotherapyd 278 181 – 619 311 200 – 688 5 months LogNormal PC and CL
Surveillance during first yearg 118 48 – 189 123 64 – 179 12 months LogNormal PC
After first year of LR
Cost of endocrine therapyc
Tamoxifen 12.4 11.6 – 13.2 12.4 11.6 – 13.2 48 months LogNormal DPIN
Aromatase inhibitors 156 120 193 48 months LogNormal DPIN
Sequential aromatase → tamoxifen 72 62 81 48 months LogNormal DPIN
Surveillance after first year of LRg 98 33 – 162 78 18 – 139 Life time LogNormal PC
Cost associated with DR (per month), $
First year after DR
Hospitalization cost 841 138 – 253 1569 185 3177 12 months LogNormal HA and CL
Physicians cost 247 64 – 431 353 205 – 501 12 months LogNormal PC
Drugs cost 19 5 – 34 83 29 – 134 12 months LogNormal DPIN
After first year of DR
Hospitalization cost 1293 146 – 3014 783 72 – 1618 Life time LogNormal HA and CL
Physicians cost 204 86 – 322 183 62 – 337 Life time LogNormal PC
Drugs cost 52 5 – 121 100 33 – 167 Life time LogNormal DPIN

Beta distribution was used for other probability parameter estimates not included in this table.

The baseline utility for post-menopausal women aged 50 to 80 was 0.824 and for premenopausal women aged 20 to 49 was 0.89 [51]. We derived utilities for each state by multiplying these baseline utility values by utility estimates for women with breast cancer [41,52-54], consistent with methodology as described by Fryback [55].

a Cost of breast cancer surgery: We used the Hospital Discharge Database and the Physician Claims Database to estimate the mean cost of hospitalization due to any breast cancer surgery (including one day hospitalization and using the ICD-9-CM procedure codes for a hospital abstract) within one year after diagnosis with ESBC and LR by menopausal status.

b Cost of radiation therapy: Cost of radiation therapy included cost of radiation therapy–related physician claims in addition to administrative cost. We used the Physician Claims Database to estimate the mean cost of radiation therapy–related physician claims (using the tarrif code for a medical claim) within one year after diagnosis with ESBC and LR by menopausal status. Administrative costs were derived from the cost list for Manitoba health services.

c Cost of endocrine therapy: We used the Drug Program Information Network to estimate the mean cost of tamoxifen and aromatase inhibitors by menopausal status (using the drug identification number for a drug claim) within the time periods, between diagnosis with ESBC and before any relapse, and diagnosis with LR and before any relapse.

d Cost of chemotherapy: Nursing, overhead and administration costs were derived from the cost list for Manitoba health Services. We used the Physician Claims Database to estimate the mean cost of chemotherapy–related physician claims costs (using the tarrif code for a medical claim) within one year after diagnosis with ESBC and LR by menopausal status. Chemotherapy regimens costs were estimated based on the market prices as of May 2010.

e Weighted average cost of adjuvant chemotherapy regimens: We calculated the average cost of adjuvant chemotherapy regimens weighted to the observed proportion use of anthracyclines and taxanes by menopausal status. Weighted average cost of adjuvant chemotherapy regimens = proportion of women received non-anthracyclines containing adjuvant chemotherapy × cost of CMF + proportion of women received anthracyclines containing adjuvant chemotherapy (no added taxanes) × cost of AC + proportion of women received anthracyclines and taxanes containing adjuvant chemotherapy × cost of TAC.

f Cost of CSAE: We used the Hospital Discharge Database and the Physician Claims Database to estimate the mean cost associated with hospitalizations due to any of the eight diagnoses which were considered CSAE among women who develop CSAE. We stratified the analysis by menopausal status.

g Cost of surveillance: We defined the cost of breast cancer surveillance as the incremental cost of health care utilization (medical claims) after diagnosis with ESBC versus the time before diagnosis. We used the Physician Claims Database to collect medical claims for both post- and pre-menopausal women, within 3 years before and 7 years after diagnosis with ESBC. We estimated the mean cost of medical claims by menopausal status within 3 years before diagnosis in order to reflect the usual cost of health care utilization. We calculated the incremental mean cost of health care utilization by menopausal status during the period from diagnosis with ESBC and before any relapse (excluding cost of claims related to surgery, radiation therapy, chemotherapy and CSAE) stratified by the time following diagnoses (first year versus later). Similarly, we calculated the incremental mean cost of health care utilization by menopausal status after LR

PSA = probabilistic sensitivity analysis; MCR = Manitoba Cancer Registry: PC = physician claims; HA = hospital abstracts; CL = cost list for Manitoba health services; DPIN = Drug Program Information Network records; ESBC = early stage breast cancer; LR, loco-regional recurrence; DR = distant recurrence; CMF = 6 cycles of cyclophosphamide, methotrexate, 5-fluorouracil; AC = 4 cycles of adriamycin, cyclophosphamide; FAC = 6 cycles of fluorouracil, doxorubicin, cyclophosphamide; TAC = 6 cycles of docetaxel, doxorubicin, cyclophosphamide; CCP = current clinical practice.

Hannouf et al.

Hannouf et al. BMC Cancer 2012 12:447   doi:10.1186/1471-2407-12-447

Open Data