A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in Early HER2/<i>neu</i>–Positive Breast Cancer

Kurian, Allison W.; Thompson, Rebecca Newton; Gaw, Allison F.; Arai, Sally; Ortiz, Rafael; Garber, Alan M.

doi:10.1200/jco.2006.06.3081

Cited by 110 publications

(111 citation statements)

References 32 publications

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“…21 More recent studies have concluded that one year of adjuvant Herceptin therapy is a cost-effective treatment for early breast cancer. 22,23 An assessment of the Australian context concluded that given as adjuvant therapy, Herceptin 'may be cost-effective when given over either 52 or 9 weeks at current acquisition costs', 24 also noted that the cost-effectiveness 'with respect to mortality remains uncertain'. 24 Another concern is whether subsidization means that other treatments will be disadvantaged, given limited healthcare budgets.…”

Section: Introductionmentioning

confidence: 99%

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

et al. 2008

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Summary Background In August 2006, the Australian government announced that Herceptin (Trastuzumab) would be added to the national Pharmaceutical Benefits Scheme (PBS) of government-subsidized drugs, for treatment with adjuvant chemotherapy of HER2 breast cancer. Following initial reticence, the health minister responded to a campaign by patients and patient advocacy groups by announcing PBS subsidization which lowered the cost of a weekly dose from A$1000 to A$30. The cost to the government would be A$470 million over three years for treatment of an estimated 2100 women annually. Design We analysed the news frames used in all direct and attributed statements ( n=239) in television news coverage of the discourse preceding the Herceptin decision by the Australian government. Setting Five Sydney free-to-air channels between October 2005 and August 2006. Main outcome measures News frames or themes. Results Of five news frames identified, one (‘desperate, sick women in double jeopardy because of callous government/incompetent bureaucracy’) accounted for 54% of all reported statements. Government financial parsimony was framed as responsible for the women's plight, with drug industry pricing never mentioned. Claimed benefits of Herceptin often conflated cancer non-recurrence and survival and favoured quantification rhetoric which emphasized percentage increases in improvement rather than the more modest increases in absolute survival. Conclusions News frames invoking key tenets of the ‘rule of rescue’ dominated television discourse on Herceptin. Clinicians, patients, their families and patient advocacy groups invoking the rule of rescue can increase the likelihood of achieving their objective of gaining access to expensive healthcare such as pharmaceuticals. Rational, criteria-based public health policy will find it hard to resist the rule of rescue imperative.

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Section: Introductionmentioning

confidence: 99%

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

et al. 2008

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“…In addition to the cost of diagnostic testing, significant treatment costs include acquisition costs, administration costs (nursing and pharmacy time), and the costs of clinical cardiac monitoring. Numerous cost-effectiveness studies suggest that costs are comparable to other accepted and standard uses of healthcare dollars [42][43][44][45][46] ; nevertheless, factoring in treatment costs when selecting from among safe and effective treatment options improves the overall cost-benefit ratio of the intervention. Selected treatment costs for chemotrastuzumab sequences and concurrent trastuzumab-taxane regimens are summarized in Table 4.…”

Section: How Do Trastuzumab-based Regimens Compare In Terms Of Cost?mentioning

confidence: 99%

Adjuvant targeted therapy in early breast cancer

Mackey

McLeod²,

Ragaz

et al. 2009

Cancer

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For this review, the authors appraised the evidence for adjuvant trastuzumab therapy in early breast cancer. There was level 1 evidence to support the routine use of 1 year of adjuvant trastuzumab in conjunction with chemotherapy for women with human epidermal growth factor receptor 2 (HER-2)-positive early breast cancer. The relative benefits of concurrent versus sequential administration remained unclear; however concurrent administration permitted the earliest possible intervention with trastuzumab with possible superiority. There was evidence to support the use of trastuzumab in both lymph node-positive and highrisk lymph node-negative patients, and preliminary data suggested that all patient subgroups that were eligible for the trials benefit equally from trastuzumab. Adjuvant trastuzumab was associated with a risk of cardiotoxicity, the long-term impact of which remains largely unknown. Routine cardiac risk assessment considering left ventricular ejection fraction, age, and prior history of cardiac events is recommended along with the selection of trastuzumab-based regimens that minimize cardiotoxicity. Increased knowledge of the biologic diversity of breast cancer has been accompanied by increased efforts to individualize breast cancer treatment based on the underlying molecular features of each tumor. Approximately 15% to 20% of early breast cancers have amplification of the human epidermal receptor-2 (HER-2) gene, with resultant overexpression of the HER-2 protein. 1-3 HER-2 belongs to a family of 4 transmembrane receptor tyrosine kinases that mediate the growth, differentiation, and survival of cells. [4][5][6] Tumors that over express this protein are imbued with more aggressive qualities, including enhanced growth and proliferation, increased invasive and metastatic capability, and stimulation of angiogenesis. 4,6 Individual trials, population-based studies, and retrospective analyses also have shown that HER-2 overexpression is associated with poorly differentiated, high-grade tumors and lymph node involvement. 4 We thank Kaleidoscope Strategic Inc., for the information management services required for developing this review.

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“…Although the response to endocrine therapies is slightly lower for patients with HER-2ϩ tumors, one would still expect that the recurrence risk would be reduced to ϳ10% with adequate hormonal therapy. If we were to extrapolate the benefit of adjuvant trastuzumab with chemotherapy from the large adjuvant trials (Table 1), this risk could be reduced to about 5% with an adjuvant trastuzumab-based chemotherapy regimen, but it would include a risk up to 5% for cardiomyopathy and a cost of as much as $50,000 (trastuzumab) to $100,000 per year (with chemotherapy) [14]. Third, the pros and cons of various adjuvant trastuzumab regimens need to be carefully weighed.…”

Section: By Aditya Bardia Massachusetts General Hospital Cancer Centementioning

confidence: 99%

“…However, the predominantly anthracycline and taxane chemotherapy backbone used in the adjuvant trials may not be necessary for all patients, in particular those with tumors Ͻ1 cm or with negative lymph nodes. Trials evaluating trastuzumab in combination with single-agent taxanes [13] or docetaxel and cyclophosphamide [14], for example, may provide alternative treatment strategies for this subgroup of patients. In addition, whether or not some women may gain the most benefit from an adjuvant approach that uses anti-HER-2 therapy alone is of great interest, and clinical trials are currently being designed to evaluate this question.…”

Section: By Aditya Bardia Massachusetts General Hospital Cancer Centementioning

confidence: 99%

Trastuzumab for Small HER-2+ Breast Cancer: Small Tumor, Big Decision

Connolly

Bardia

2012

The Oncologist

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A 53-year-old postmenopausal woman was found to have a new area of microcalcification at the 10 o'clock position of her right breast during a routine screening mammogram. Ultrasound-guided core biopsy revealed a grade 2 invasive ductal carcinoma, estrogen receptor (ER)؉ (90%), progesterone receptor positive (20%), and human epidermal growth factor receptor (HER)-2؉ (3؉ by immunohistochemistry). A right breast lumpectomy and sentinel node biopsy were performed. The invasive tumor measured 0.7 cm, no lymphovascular space invasion was identified, surgical margins were uninvolved, and the sentinel lymph nodes were negative for tumor. She was evaluated postoperatively in the medical oncology clinic to discuss an adjuvant treatment strategy.The question for our colleagues is: should she be offered adjuvant chemotherapy and trastuzumab prior to adjuvant radiation and 5 years of hormonal therapy? PRO

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A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in Early HER2/neu–Positive Breast Cancer

Abstract: AT has an ICER comparable to those for other widely used interventions. Longer clinical follow-up is warranted to evaluate the long-term efficacy and toxicity of different AT regimens.

Cited by 110 publications

References 32 publications

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

Adjuvant targeted therapy in early breast cancer

Trastuzumab for Small HER-2+ Breast Cancer: Small Tumor, Big Decision

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