We randomized 81 postmenopausal women with advanced breast cancer, whose tumors were rich in estrogen receptors or of unknown estrogen-receptor status, to receive either estrogen therapy alone or estrogen therapy combined with chemotherapy. An additional 31 patients, whose tumors were poor in estrogen receptors, were randomized to receive either chemotherapy alone or estrogen combined with chemotherapy. The median duration of follow-up was 87 months. In the receptor-rich group, the survival of the 21 patients receiving combined therapy was significantly longer than that of 19 patients receiving estrogen as initial therapy (followed by chemotherapy after failure or relapse). The median survivals were 72 and 29 months, respectively (P = 0.05 by the generalized Wilcoxon method). Among 41 patients with tumors of unknown receptor status, a survival advantage from combined therapy over chemotherapy was seen in the first two years and then disappeared. The survival in 31 patients with receptor-poor tumors was uniformly short regardless of the therapeutic method. We conclude that combined therapy offers a survival advantage in postmenopausal patients with receptor-rich tumors.

Three hundred and twelve patients suffering from painful conditions were admitted to a multicentre, double-blind controlled trial, conducted in general practice in which five analgesics--floctafenine (Idarac), paracetamol, aspirin, dihydrocodeine and pentazocine--were compared. Overall ratings of analgesic effect placed floctafenine first in rank order. Floctafenine was statistically significantly superior in effect to pentazocine but not to the other three agents as far as doctor ratings were concerned; and superior to both pentazocine and dihydrocodeine in the opinion of patients. Fewer patients experienced side-effects on floctafenine than on the other four analgesics and this difference between floctafenine and pentazocine, and floctafenine and dihydrocodeine was statistically significant.

and net monetary benefit calculations. Sensitive variables include abiraterone costs and neutropenia costs of mitozantrone. Even assuming most patients are severely ill to match sites with sicker populations, the relative cost-effectiveness does not change; abiraterone favored and cabazitaxel always above tolerable thresholds. CONCLUSIONS: Abiraterone is the most cost effective given WTP of $100,000. Despite slightly higher survival with cabazitaxel, it is never cost-effective with high drug and neutropenia costs. Even for care sites with relatively ill patients, abiraterone remains cost-effective. OBJECTIVES:Cancer is a risk factor to develop deep vein thrombosis (DVT), pulmonary embolism (PE) or relapse of these conditions. Alternatives to oral anticoagulants need to be evaluated. The objective of this study was to perform an economic evaluation of anticoagulant therapies in adult patients with cancer (solid tumors), from the Social Security Mexican Institute (IMSS) perspective. METHODS: One-year medical direct costs (2011 US$) and health consequences were estimated by a Markov model (one-week cycles). Effectiveness measures were reduction in cases of DVT and PE (per 1000 patients). A meta-analysis was performed to estimate transition probabilities. Alternatives considered in the assessment were: warfarin (5mg/day); dalteparin (not listed in Mexican formulary, 5000 IU/day); enoxaparin (40 mg/day); nadroparin (5700 IU/day); unfractionated heparin (UFH) plus warfarin (10000 IU/dayϩ5 mg/day) and no prophylaxis. Resource use and costs were obtained through IMSS databases (dalteparin acquisition cost was provided by manufacturer). Univariate sensitivity analysis was performed. Acceptability curves were constructed. RESULTS: Estimated cases of DVT avoided were: warfarin 276 (CI 95% 271-281); dalteparin 47 (46 -48); enoxaparin 107 (105-109); nadroparin 97 (95-99); UFH 127 (124 -130) and no prophylaxis 317 (310 -323). Regarding PE prevention, outcomes were: warfarin 116 (114 -118); dalteparin 16 (16 -16); enoxaparin 23 (23-23); nadroparin 15 (15-15); UFH 26 (25-27) and no prophylaxis 61 (60 -62).

Markov model with 3 stages: disease progression, disease free progression and death in a time horizon of 3 years. Costs were based on direct medical costs of the institution, drug administration costs and cost for the management of adverse events and they are expressed in US dollars. RESULTS: The average treatment cost for the alternatives were: $ 16,133.78 for XELOX, $ 25,690.58 for FOLFOX-4, $ 27,686.35 for FOLFOX-6 and $ 21,904.12 for FOLFIRI. XELOX is the least costly alternative. The difference in costs is mainly due to the difference in management costs and the presence of grade 3-4 adverse events, mainly neutropenia. Based on clinical trials, FOLFOX-6 presented neutropenia (47%), FOLFOX-4 (44%) and FOLFIRI (26%), while the most severe adverse event was diarrhea with XELOX (12%). In the disease management, FOLFOX-6, FOLOFX-4 and FOLFIRI require two hospitalizations per cycle for the application of the drug. Instead, XELOX requires only one chemotherapy session. Since Capecitabine is orally administered, not only minimizes the costs of administration, also has a better safety profile with less adverse events. CONCLUSIONS: The use of Capecitabine combined with Oxaliplatin scheme as first-line treatment of metastatic colorectal cancer, is the alternative that minimizes costs to the health institutions, as well as improve quality of life resulting from Capecitabine's oral administration.

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