A cost-effectiveness analysis of adjuvant trastuzumab regimens in early HER2/neu-positive breast cancer
A cost-effectiveness analysis of adjuvant trastuzumab regimens in early HER2/neu-positive breast cancer
复制标题
DOI：
10.1200/jco.2006.06.3081
复制
发表时间：
2007-02-20
影响因子：
45.3
通讯作者：
Garber, Alan M.
中科院分区：
文献类型：
--
作者：
Kurian, Allison W.;Newton Thompson, Rebecca;Garber, Alan M.
目的一年曲妥珠单抗（AT）辅助治疗（联合或不联合蒽环类药物）可提高早期HER 2/neu阳性乳腺癌的无病生存期和总生存期。我们试图评估这些方案的成本效益，这是昂贵的和潜在的toxic.MethodsWe使用马尔可夫健康状态转换模型，以模拟三个辅助治疗方案的一个队列的49岁的妇女与HER 2/neu阳性早期乳腺癌：传统化疗没有曲妥珠单抗;在国家外科辅助乳腺和肠道项目B-31和北中央癌症治疗组N9831试验中使用的基于蒽环类药物的AT方案;以及乳腺癌国际研究组006试验中使用的非蒽环类AT方案。基础病例使用AT随机临床试验中报告的治疗疗效指标。我们测量的健康结果的质量调整生命年（QALYS）和成本在2005年美元（US$）和结果进行概率敏感性analysis.ResultsIn的基础情况下，蒽环类抗生素为基础的AT手臂有一个增量成本效益比（ICER）为39,982美元/QALY，而nonanthracycline AT手臂是更昂贵，更有效;这一结果对复发率的变化不敏感，但如果4年后没有获益，两个AT组的ICER均超过100，000美元/QALY。结果是中度敏感的乳腺癌的生存率和曲妥珠单抗的成本变化，在心脏toxicity.ConclusionAT的变化不太敏感的ICER相媲美的其他广泛使用的干预措施。不同AT方案的长期疗效和毒副反应有待进一步临床随访。
PurposeOne-year adjuvant trastuzumab ( AT) therapy, with or without anthracyclines, increases disease-free and overall survival in early-stage HER2/neu-positive breast cancer. We sought to evaluate the cost effectiveness of these regimens, which are expensive and potentially toxic.MethodsWe used a Markov health-state transition model to simulate three adjuvant therapy options for a cohort of 49-year-old women with HER2/neu-positive early-stage breast cancer: conventional chemotherapy without trastuzumab; anthracycline-based AT regimens used in the National Surgical Adjuvant Breast and Bowel Project B-31 and North Central Cancer Treatment Group N9831 trials; and the nonanthracycline AT regimen used in the Breast Cancer International Research group 006 trial. The base case used treatment efficacy measures reported in the randomized clinical trials of AT. We measured health outcomes in quality-adjusted life-years (QALYs) and costs in 2005 United States dollars (US$) and subjected results to probabilistic sensitivity analysis.ResultsIn the base case, the anthracycline-based AT arm has an incremental cost-effectiveness ratio ( ICER) of $39,982/QALY, whereas the nonanthracycline AT arm is more expensive and less effective; this result is insensitive to changes in recurrence rates, but if there is no benefit after 4 years, ICERs exceed $100,000/QALY for both AT arms. Results are moderately sensitive to variation in breast cancer survival rates and trastuzumab cost, and less sensitive to variations in cardiac toxicity.ConclusionAT 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.