ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country
ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country
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DOI：
10.15446/rsap.v16n2.31690
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发表时间：
2014-03-01
期刊：
影响因子：
--
通讯作者：
Castañeda-Orjuela, Carlos
中科院分区：
文献类型：
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作者：
Chicaíza-Becerra, Liliana;García-Molina, Mario;Castañeda-Orjuela, Carlos
目的：乳腺癌（BC）和转移性乳腺癌（MBC）是全世界妇女死亡的重要原因，包括发展中国家。在后者，治疗费用比在高收入国家更成问题。ErbB2过表达是预后不良的标志物，也是靶向治疗的目标。本研究的目的是在评估的成本效益，在哥伦比亚的ErbB2+ MBC治疗后的进展曲妥珠单抗。方法：一个决策分析模型的构建，以评估这种治疗在一个假设的队列ErbB2+MBC患者谁进展后，第一个计划涉及曲妥珠单抗。比较的替代方案为拉帕替尼+卡培他滨（L+C）和曲妥珠单抗+化疗药物（卡培他滨、长春瑞滨或紫杉烷）。马尔可夫模型用于计算无进展时间和相关成本。这种治疗的有效性估计是从初步研究中确定的，所有基于国家收费指南的直接医疗费用都包括在内。分析了灵敏度并估计了可接受性曲线。3%的贴现率和第三付款人的角度在5年的horizon.RESULTS：L+C占主导地位的比较。其成本效益比为每无进展年49，725，045缔约方会议美元。最影响结果的因素是替代品的风险比和成本trastuzumab.CONCLUSION：拉帕替尼是成本效益相比，其替代品治疗MBC后，曲妥珠单抗使用哥伦比亚决策分析模型进展。
OBJECTIVE: Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst women worldwide, including developing countries. The cost of treatment in the latter is even more of an issue than in higher income countries. ErbB2 overexpression is a marker of poor prognosis and the goal for targeted therapy. This study was aimed at evaluating the cost-effectiveness in Colombia of ErbB2+ MBC treatment after progression on trastuzumab.METHODS: A decision analytic model was constructed for evaluating such treatment in a hypothetical cohort of ErbB2+MBC patients who progressed after a first scheme involving trastuzumab. The alternatives compared were lapatinib+capecitabine (L+C), and trastuzumab+a chemotherapy agent (capecitabine, vinorelbine or a taxane). Markov models were used for calculating progression-free time and the associated costs. Effectiveness estimators for such therapy were identified from primary studies; all direct medical costs based on national fees-guidelines were included. Sensitivity was analyzed and acceptability curves estimated. A 3 % discount rate and third-payer perspective were used within a 5-year horizon.RESULTS: L+C dominated its comparators. Its cost-effectiveness ratio was COP $49,725,045 per progression-free year. The factors most influencing the results were the alternatives' hazard ratios and the cost of trastuzumab.CONCLUSION: Lapatinib was cost-effective compared to its alternatives for treating MBC after progression on trastuzumab using a Colombian decision analytic model.