A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer.
A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer.
复制标题
DOI：
10.1007/s10549-015-3383-6
复制
发表时间：
2015-05
影响因子：
3.8
通讯作者：
Montero AJ
中科院分区：
文献类型：
--
作者：
Diaby V;Tawk R;Sanogo V;Xiao H;Montero AJ
乳腺癌是一个全球性的健康问题。事实上，乳腺癌是全世界妇女死亡的主要原因，也是治疗费用最高的恶性肿瘤。由于卫生保健资源有限，关于采用和覆盖乳腺癌治疗的决定越来越多地基于"物有所值"，即，成本效益。由于有关乳腺癌治疗成本效益的证据非常丰富，因此难以浏览，已发表系统性综述的系统性综述提供了将单独系统性综述的结果汇总在一份报告中的优势。因此，本文概述了乳腺癌激素治疗、化疗和靶向治疗的成本效益的系统评价，为政策和报销决策提供信息。对2000年至2014年期间记录乳腺癌治疗成本效益分析的已发表系统性综述进行了系统性综述。根据纳入和排除标准，对通过健康和经济数据库文献检索确定的系统性综述进行独立评估。只有针对乳腺癌患者和特定乳腺癌治疗（仅激素治疗、化疗和靶向治疗），记录增量成本-效果比，并以英语报告时，才纳入原始评价的系统性综述。检索策略使用了这些关键词的组合："乳腺癌"、"系统综述/荟萃分析"和"成本效益/经济学"。使用预定义的提取表提取数据，并使用多系统评价评估（AMSTAR）工具进行定性评价。文献检索得到511条书目记录，其中10条符合我们的纳入标准。在早期乳腺癌环境中进行了5次审查，在转移性环境中进行了5次审查。在早期乳腺癌中，关于曲妥珠单抗价值的证据因年龄而异。曲妥珠单抗仅在年龄小于65岁的HER2阳性乳腺癌女性中具有成本效益，并且在终身范围内。曲妥珠单抗治疗HER2阳性转移性乳腺癌的成本-效果产生了相互矛盾的结果。在长春瑞滨和紫杉烷类之间的比较中得出了相同的结论。在早期和晚期/转移性乳腺癌中，较新的芳香化酶抑制剂（AI）与较旧的治疗方法相比具有成本效益。这篇系统性综述表明，有关乳腺癌激素治疗、化疗和靶向治疗的成本效益的证据存在异质性。这些治疗的成本效益不仅取决于对照药物，还取决于背景，即，辅助或转移性情况、患者人群的亚型和采用的观点。通过更好地协调评估这些治疗价值的经济评价报告，可以使涉及乳腺癌治疗成本效益的决定更容易和更透明。
Breast cancer is a global health concern. In fact, breast cancer is the primary cause of death among women worldwide and constitutes the most expensive malignancy to treat. As health care resources are finite, decisions regarding the adoption and coverage of breast cancer treatments are increasingly being based on “value for money,” i.e., cost-effectiveness. As the evidence about the cost-effectiveness of breast cancer treatments is abundant, therefore difficult to navigate, systematic reviews of published systematic reviews offer the advantage of bringing together the results of separate systematic reviews in a single report. As a consequence, this paper presents an overview of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer to inform policy and reimbursement decision-making. A systematic review was conducted of published systematic reviews documenting cost-effectiveness analyses of breast cancer treatments from 2000 to 2014. Systematic reviews identified through a literature search of health and economic databases were independently assessed against inclusion and exclusion criteria. Systematic reviews of original evaluations were included only if they targeted breast cancer patients and specific breast cancer treatments (hormone therapy, chemotherapy, and targeted therapy only), documented incremental cost-effectiveness ratios, and were reported in the English language. The search strategy used a combination of these key words: “breast cancer,” “systematic review/meta-analysis,” and “cost-effectiveness/economics.” Data were extracted using predefined extraction forms and qualitatively appraised using the assessment of multiple systematic reviews (AMSTAR) tool. The literature search resulted in 511 bibliographic records, of which ten met our inclusion criteria. Five reviews were conducted in the early-stage breast cancer setting and five reviews in the metastatic setting. In early-stage breast cancer, evidence about trastuzumab value differed by age. Trastuzumab was cost-effective only in women with HER2-positive breast cancer younger than 65 years and over a life-time horizon. The cost-effectiveness of trastuzumab in HER2-positive metastatic breast cancer yielded conflicting results. The same conclusions were reached in comparisons between vinorelbine and taxanes. In both early stage and advanced/metastatic breast cancer, newer aromatase inhibitors (AIs) have proved cost-effective compared to older treatments. This overview of systematic reviews shows that there is heterogeneity in the evidence concerning the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer. The cost-effectiveness of these treatments depends not only on the comparators but the context, i.e., adjuvant or metastatic setting, subtype of patient population, and perspective adopted. Decisions involving the cost-effectiveness of breast cancer treatments could be made easier and more transparent by better harmonizing the reporting of economic evaluations assessing the value of these treatments.