LAUSR

Abstract Although recent studies demonstrated that fulvestrant is superior to anastrozole as first‐line treatment for hormone receptor (HR)‐positive advanced breast cancer, the cost‐effectiveness of fulvestrant versus anastrozole remained uncertain. Thus, the current study aimed to evaluate the cost‐effectiveness of fulvestrant compared with anastrozole in the first‐line setting. A Markov model consisting of three health states (stable, progressive and dead) was constructed to simulate a hypothetical cohort of patients with HR‐positive advanced breast cancer. Costs were calculated from a Chinese societal perspective. Health outcomes were measured in quality‐adjusted life‐year (QALY). The incremental cost‐effectiveness ratio (ICER) was expressed as incremental cost per QALY gained. Model results suggested that fulvestrant provides an additional effectiveness gain of 0.11 QALYs at an incremental cost of $32,654 compared with anastrozole, resulting in an ICER of $296,855/QALY exceeding the willingness‐to‐pay threshold of $23,700/QALY. Hence, fulvestrant is not a cost‐effective strategy compared with anastrozole as first‐line treatment for HR‐positive advanced breast cancer.