Cost-Effectiveness Analysis of Trastuzumab in the Adjuvant Treatment for Early Breast Cancer

Abstract

Background:Evidence from randomized controlled trials (RCTs) has shown a significant survival advantage of trastuzumab. Although extant work in developed countries examined economic evaluation of trastuzumab in adjuvant treatment for early breast cancer based on the 1-year treatment, there is uncertainty about cost-effectiveness of trastuzumab in the Adjuvant Treatment of early breast cancer in developing countries. This study aimed to estimate cost-effectiveness of adjuvant trastuzumab therapy compared to AC-T regimen in early breast cancer in Iran.Methods:A cost-effectiveness analysis was performed using a Markov model to estimate outcomes and costs over a 20-year time period using a cohort of women with HER2 positive early breast cancer, treated with or without 12 months trastuzumab adjuvant chemotherapy. Transition probabilities were derived mainly from the BCIRG006 trial. Costs were estimated from the perspective of the Iranian health care system. Both costs and outcomes were discounted by 3%. One-way sensitivity analysis was undertaken to assess the associated uncertainties in the expected output measures.Results:On the basis of BCIRG006 trial, our model showed that adjuvant trastuzumab treatment in early breast cancer, yield 0.87 quality-adjusted life-years (QALY) compared with AC-T regimen. Adjuvant trastuzumab treatment yielded an incremental cost-effectiveness ratio (ICER) of US$ 51302 per QALY.Conclusion:By using threshold of 3 times GDP per capita, as per World Health Organization (WHO) recommendation, 12 months trastuzumab adjuvant chemotherapy is not a cost-effective therapy for patients with HER2-positive breast cancer in Iran.

Anti-ErbB2 immunotherapeutics: struggling to make better antibodies for cancer therapy

“…14 Similarly, a cost-effectiveness analysis performed in Iran of 1-year trastuzumab adjuvant chemotherapy for early breast cancer, estimating outcomes, coverage and costs over a 20-year period, concluded that the treatment would not be cost-effective in this country. 15 The same conclusion was reached in a pharmacoeconomic study evaluating the addition of trastuzumab to standard chemotherapy in patients with advanced gastric cancer in China. 16 On the other hand, 1-year trastuzumab adjuvant chemotherapy for early breast cancer has been found cost-effective in Taiwan where, since 2010, the national health system (NHS) started to reimburse the treatment, having fixed a willingnessto-pay threshold at 3-times the per capita gross domestic product.…”

A Critical Review of Economic Evaluations of Trastuzumab in the Treatment of Early Stage HER2 Positive Breast Cancer

“…Modelling, however, often involves the use of many assumptions often based on adjustments of findings from earlier studies [40,47,55,59,60]. The reasonableness of these assumptions, however are central to the quality of model and the validity of its predictions.…”

“…For example, different studies use different modelling approaches, while most use a Markov modelling approach (including health-state transition model [47,61,62], life-long state transition model [63], a discrete-state time dependent semi-Markov model [64]), others use dynamic models (dynamic life-cycle model [35]). The number of states modelled also varies markedly from 3 to 10 states of disease [45,47,51,55,59,64], the variation reflecting in part the focus of the authors (such as cardiac toxicity, recurrence or relapse, HER2 testing and Trastuzumab regime) and the willingness of authors to balance complexity with transparency in models. How models are populated also varies though the relatively small number of trials relating to use of Trastuzumab in early stage breast cancer has served to limit heterogeneity here.…”

A Comparative Study for Modelling the Survival of Breast Cancer Patients in the West of Iran

“…Breast cancer as the most common cancer among Iranian females (Aboutorabi, Hadian, Ghaderi, Salehi, & Ghiasipour, 2015), is word widely the 18% proportional share of all cancers in women (Cvetković & Nenadović, 2016). Certainly, the prerequisites for the disease prevention and proficient treatment findings are the precise detection of affective risk factors in diseases formation and progression (Mert, Kılıç, Bilgili, & Akan, 2015).…”