Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer
Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer
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DOI：
10.1002/cncr.22806
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发表时间：
2007-08-01
期刊：
影响因子：
6.2
通讯作者：
Perez, Edith A.
中科院分区：
文献类型：
--
作者：
Garrison, Louis R., Jr.;Lubeck, Deborah;Perez, Edith A.
背景。在辅助化疗中添加曲妥珠单抗可为人类表皮生长因子受体 2 (HER2) 阳性乳腺癌患者带来显着的临床益处。基于 NSAIBP B-31 和 NCCTG N9831 试验的联合分析，进行了成本效益分析，以评估在辅助化疗中添加曲妥珠单抗的临床和经济影响。方法。根据 4 年的试验结果，使用具有 4 种健康状态的马尔可夫模型来估计一名 50 岁女性的成本效用，并根据试验的荟萃分析估计长期复发和死亡。从 6 年起，假设曲妥珠单抗组和单纯化疗组的复发率和死亡率相同。估算了诊断和治疗相关费用的增量成本。分析是从付款人和社会角度进行的，这些分析预计到终生和 20 年的范围内。结果。在一生中，曲妥珠单抗每个质量调整生命年（QALY；贴现率 3%）的预计成本为 26,417 美元（根据多方敏感性分析，范围为 9104 美元至 0,340 美元）。折扣增量终生成本为 44,923 美元，接受曲妥珠单抗治疗的患者的预计预期寿命延长 3 年（19.4 岁 vs 16.4 岁）。在 20 年范围内，在化疗中添加曲妥珠单抗的预计成本为每获得 QALY 34,201 美元。关键的成本效益驱动因素是折扣率、曲妥珠单抗价格和转移概率。成本效益结果对敏感性分析是稳健的。结论。用于早期乳腺癌辅助治疗的曲妥珠单抗预计在整个生命周期内具有成本效益，其成本效益比低于许多广泛接受的肿瘤治疗。
Background. Adding trastuzumab to adjuvant chemotherapy provides significant clinical benefit in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. A cost-effectiveness analysis was performed tc assess clinical and economic implications of adding trastuzumab to adjuvant chemotherapy, based upon joint analysis of NSAIBP B-31 and NCCTG N9831 trials.Methods. A Markov model with 4 health states was used to estimate the cost utility for a 50-year-old woman on the basis of trial results through 4 years and estimates of long-term recurrence and death based on a meta-analysis of trials. From 6 years onward, rates of recurrence and death were assumed to be the same in both trastuzumab and chemotherapy-only arms. Incremental costs were estimated for diagnostic and treatment- related costs. Analyses were from payer and societal perspectives, and these analyses were projected to lifetime and 20-year horizons.Results. Over a lifetime, the projected cost of trastuzumab per quality-adjusted life year (QALY; discount rate 3%) gained was $26,417 (range, $9104-$0,340 under multiway sensitivity analysis). Discounted incremental lifetime cost was $44,923, and projected life expectancy was 3 years longer for patients who received trastuzumab (19.4 years vs 16.4 years). During a 20-year horizon, the projected cost of adding trastuzumab to chemotherapy was $34,201 per QALY gained. Key cost-effectiveness drivers were discount rate, trastuzumab price, and probability of metastasis. The cost-effectiveness result was robust to sensitivity analysis.Conclusions. Trastuzumab for adjuvant treatment of early stage breast cancer was projected to be cost effective over a lifetime horizon, achieving a cost-effectiveness ratio below that of many widely accepted oncology treatments.