Short-course adjuvant trastuzumab therapy in early stage breast cancer in Finland: Cost-effectiveness and value of information analysis based on the 5-year follow-up results of the FinHer Trial

Purmonen, Timo; Pänkäläinen, Emma; Turunen, Juha; Asseburg, Christian; Martikainen, Janne

doi:10.3109/0284186x.2011.553841

Cited by 47 publications

(44 citation statements)

References 21 publications

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“…On the other hand, when cure is not obtained, high treatment costs continue throughout life. If the efficacy of 9 weeks of injections as per the FinHer trial is nearly equal to that of 1 year of injections, the 9-week treatment would be more cost-effective [18].…”

Section: Discussionmentioning

confidence: 99%

High recurrence risk and use of adjuvant trastuzumab in patients with small, HER2-positive, node-negative breast cancers

et al. 2011

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Section: Discussionmentioning

confidence: 99%

High recurrence risk and use of adjuvant trastuzumab in patients with small, HER2-positive, node-negative breast cancers

et al. 2011

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“…The probabilities of progression from disease-free to distant disease, and from distant disease to death, were taken from a previously published CEA based on the FinHer trial data [36] as this analysis provided appropriate Markov transition probabilities for this patient group, corresponding to the specific health state transitions in our three-state model. Costs and utilities were applied to patient cohorts at the beginning of each cycle.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to this, joint Bayesian probabilistic sensitivity analyses (PSAs) were conducted, varying all input parameters simultaneously over 5,000 simulations, and using beta prior distributions for all proportions, rates and utilities; and gamma prior distributions for all costs. The alpha and beta parameters for the transition probabilities’ prior distributions were taken from the previously published Finnish CEA [36], and the method of moments was used to estimate alpha and beta for all other parameters based on their upper and lower limits discussed above [46]. Net monetary benefit (NMB) was calculated for a range of values of willingness to pay (WTP) for a quality-adjusted life-year (QALY), using Eq 2.…”

Section: Methodsmentioning

confidence: 99%

Multi-arm Cost-Effectiveness Analysis (CEA) comparing different durations of adjuvant trastuzumab in early breast cancer, from the English NHS payer perspective

et al. 2017

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Background Trastuzumab improves survival in HER2+ breast cancer patients, with some evidence of adverse cardiac side effects. Current recommendations are to give adjuvant trastuzumab for one year or until recurrence, although trastuzumab treatment for only 9 or 10 weeks has shown similar survival rates to 12-month treatment. We present here a multi-arm joint analysis examining the relative cost-effectiveness of different durations of adjuvant trastuzumab. Methods and findings Network meta-analysis (NMA) was used to examine which trials’ data to include in the cost-effectiveness analysis (CEA). A network using FinHer (9 weeks vs. zero) and BCIRG006 (12 months vs. zero) trials offered the only jointly randomisable network so these trials were used in the CEA. The 3-arm CEA compared costs and quality-adjusted life-years (QALYs) associated with zero, 9-week and 12-month adjuvant trastuzumab durations in early breast cancer, using a decision tree followed by a Markov model that extrapolated the results to a lifetime time horizon. Pairwise incremental cost-effectiveness ratios (ICERs) were also calculated for each pair of regimens and used in budget impact analysis, and the Bucher method was used to check face validity of the findings. Addition of the PHARE trial (6 months vs. 12 months) to the network, in order to create a 4-arm CEA including the 6-month regimen, was not possible as late randomisation in this trial resulted in recruitment of a different patient population as evidenced by the NMA findings. The CEA results suggest that 9 weeks’ trastuzumab is cost-saving and leads to more QALYs than 12 months’, i.e. the former dominates the latter. The cost-effectiveness acceptability frontier (CEAF) favours zero trastuzumab at willingness-to-pay levels below £2,500/QALY and treatment for 9 weeks above this threshold. The combination of the NMA and Bucher investigations suggests that the 9-week duration is as efficacious as the 12-month duration for distant-disease-free survival and overall survival, and safer in terms of fewer adverse cardiac events. Conclusions Our CEA results suggest that 9-week trastuzumab dominates 12-month trastuzumab in cost-effectiveness terms at conventional thresholds of willingness to pay for a QALY, and the 9-week regimen is also suggested to be as clinica...

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“…Assessing its relative value for money with specific regard to early stage disease is complicated by the fact that few evaluations of Trastuzumab in this setting provide clear definitions of what constitutes early breast cancer [39,[45][46][47][48][49]. This lack of clarity complicates not only the assessment of its cost effectiveness in this setting but also of understanding the heterogeneity in estimates of its cost effectiveness in this setting.…”

Section: Health Economic Evaluation Of Trastuzumab In the Treatment Omentioning

confidence: 99%

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

Nguyen¹,

Nguyen²,

O'Neill³

2017

Pharmacoeconomics

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Eleven years after Trastuzumab was approved for use in the treatment of early stage human epidermal growth factor receptor positive breast cancer (HER2+) its clinical benefit has been demonstrated in short and long term follow up studies. The cost-effectiveness of the therapy in this context remains the subject of debate with a wide range of Incremental Cost Effectiveness Ratios (ICERs) reported in the literature. While several reviews of the literature have been undertaken these have not provided a critical analysis of the factors that might underlie this heterogeneity. In this review we provide a critical overview of the literature and discuss potential sources of heterogeneity in reported ICERs. We identify gaps in the current literature and provide a rationale for filling these gaps.

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Short-course adjuvant trastuzumab therapy in early stage breast cancer in Finland: Cost-effectiveness and value of information analysis based on the 5-year follow-up results of the FinHer Trial

Cited by 47 publications

References 21 publications

High recurrence risk and use of adjuvant trastuzumab in patients with small, HER2-positive, node-negative breast cancers

High recurrence risk and use of adjuvant trastuzumab in patients with small, HER2-positive, node-negative breast cancers

Multi-arm Cost-Effectiveness Analysis (CEA) comparing different durations of adjuvant trastuzumab in early breast cancer, from the English NHS payer perspective

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

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