Efficacy and Cost Effectiveness of Adjuvant Chemotherapy in Women With Node-Negative Breast Cancer: A Decision-Analysis Model
Hillner, Bruce E.
Smith, Thomas J.
New England Journal of Medicine. 1991 Jan 17; 324(3): 160-168.
The purpose of this study was to explore the effectiveness of adjuvant therapy in node-negative breast cancer patients at different levels of risk of recurrence. Hillner and Smith created a model incorporating the variables of risk of recurrence, efficacy of adjuvant therapy, duration of benefit from therapy, and quality of life; and then used decision analysis to study the cost effectiveness of chemotherapy in cohorts of 45-year-old and 60-year-old women as adjusted for quality of life. They concluded from the data that chemotherapy substantially increases the quality-adjusted life expectancy of an average woman at a cost comparable to that of other widely acepted therapies. However, this benefit decreases markedly if the changes in long-term survival are less than in disease-free survival, rendering the benefit too small for many women to choose chemotherapy. This conclusion has policy implications for those who pay for cancer care. (KIE abstract)
Age Factors; Breast Cancer; Cancer; Costs and Benefits; Decision Analysis; Decision Making; Disease; Drugs; Economics; Evaluation; Evaluation Studies; Females; Health; Health Care; Life; Mortality; Patient Care; Patient Participation; Patients; Physicians; Prognosis; Prolongation of Life; Quality Adjusted Life Years; Quality of Life; Resource Allocation; Risk; Risks and Benefits; Selection for Treatment; Toxicity;
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