Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer.
Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer.
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DOI：
10.5539/gjhs.v7n1p98
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发表时间：
2014-08-14
期刊：
影响因子：
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通讯作者：
Ghiasipour M
中科院分区：
文献类型：
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作者：
Aboutorabi A;Hadian M;Ghaderi H;Salehi M;Ghiasipour M
来自随机对照试验（RCT）的证据显示曲妥珠单抗具有显著的生存优势。尽管发达国家的现有工作基于1年治疗检查了曲妥珠单抗用于早期乳腺癌辅助治疗的经济学评价，但曲妥珠单抗用于发展中国家早期乳腺癌辅助治疗的成本-效果尚不确定。本研究旨在评估曲妥珠单抗辅助治疗与AC-T方案相比在伊朗早期乳腺癌中的成本-效果。使用马尔可夫模型进行成本效益分析，以估计20年时间内的结局和成本，使用HER 2阳性早期乳腺癌女性队列，接受或不接受12个月曲妥珠单抗辅助化疗。转移概率主要来自BCIRG 006试验。费用是从伊朗保健系统的角度估计的。成本和结果均贴现3%。进行了单向敏感度分析，以评估预期产出措施的相关不确定性。在BCIRG 006试验的基础上，我们的模型显示曲妥珠单抗辅助治疗早期乳腺癌，与AC-T方案相比，获得0.87质量调整生命年（QALY）。辅助曲妥珠单抗治疗产生的增量成本-效果比（ICER）为51302美元/QALY。根据世界卫生组织（WHO）的建议，使用人均GDP 3倍的阈值，12个月曲妥珠单抗辅助化疗对伊朗的HER 2阳性乳腺癌患者来说不是一种具有成本效益的治疗。
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. 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. 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. 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.