Cost Effectiveness of Adjuvant Trastuzumab in Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer

2007 ◽  
Vol 25 (6) ◽  
pp. 625-633 ◽  
Author(s):  
Nicola Lucio Liberato ◽  
Monia Marchetti ◽  
Giovanni Barosi
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Early Breast Cancer ◽  
Growth Factor Receptor ◽  
Local Relapse ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Life Years ◽  
Epidermal Growth ◽  
The Cost

Purpose To evaluate the cost-effectiveness of 12-month adjuvant trastuzumab therapy in women with high-risk human epidermal growth factor receptor 2 (HER2) –positive early breast cancer. Methods A Markov model tracked quarterly patients’ transitions between five health states: disease free, local relapse, disease free after local relapse, metastatic disease, and death. Patients were allowed to incur symptomatic or asymptomatic transient cardiac dysfunction during trastuzumab administration. Probabilities were derived mainly from the combined report of the National Surgical Adjuvant Breast and Bowel Project B-31 and the North Central Cancer Treatment Group N9831 trials (95% node positive) and a meta-analysis by the Early Breast Cancer Trialists’ Collaborative Group. Costs were estimated from the perspective of the Italian and US health care systems. The analysis was run during a 15-year time horizon. A 3% yearly discount rate was applied to both costs and life-years. Second-order Monte-Carlo and probabilistic sensitivity analyses were performed. Results Adjuvant trastuzumab increases life expectancy by 1.54 (1.18 discounted) quality-adjusted life-years (QALYs). At a cost of €675 and $767 per weekly dose in the Italian and US setting, respectively, trastuzumab achieves its clinical benefit at a cost of €14,861 (95% CI, €3,917 to €44,028) and $18,970 (95% CI, $6,014 to $45,621) per QALY saved. The incremental cost effectiveness was higher than €50,000/QALY (or $60,000/QALY) at time horizons shorter than 7.8 years and for patients older than 76 years or with a 10-year risk of relapse lower than 15%. The results confirmed the cost effectiveness when simulating a Herceptin Adjuvant Trial (HERA) -like scenario at multiway sensitivity analysis. Conclusion In a long-term horizon, adjuvant trastuzumab is a cost-effective therapy for patients with HER2-positive, high-risk, early breast cancer.

Trastuzumab emtansine: a game changer in HER2-positive early breast cancer

2020 ◽  
Vol 16 (32) ◽  
pp. 2595-2609
Author(s):  
Max S Mano
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Pathological Complete Response ◽  
Growth Factor Receptor ◽  
Complete Response ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Epidermal Growth ◽  
Game Changer

Trastuzumab emtansine (T-DM1), given postoperatively for 14 cycles to patients with human epidermal growth factor receptor 2-positive (HER2-positive) early breast cancer (EBC) who failed to achieve a pathological complete response after standard chemotherapy and HER2 blockade, represents probably the greatest progress in the management of this aggressive form of breast cancer since the adjuvant trastuzumab pivotal trials. This article addresses the rationale behind the conception of the KATHERINE trial, T-DM1’s structure and pharmacokinetics data, clinical efficacy data of the KATHERINE trial and of other EBC trials with T-DM1, safety aspects, implications of the KATHERINE trial results to clinical practice and future perspectives in the management of HER2-positive EBC.

scholarly journals Trastuzumab As an Adjuvant Therapy for Early Breast Cancer: Economic Evaluation From a Malaysian Perspective

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 72s-72s
Author(s):  
F.K. Hanin ◽  
L. Sit Wai ◽  
J. Sabirin ◽  
W.P. Sharifa Ezat ◽  
D. Maznah
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Early Breast Cancer ◽  
Adjuvant Treatment ◽  
Cost Effective ◽  
Effective Strategy ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Common Cancer ◽  
The Cost

Background: In Malaysia, breast cancer is the most common cancer in females and also the first most common cancer among population regardless of gender. The percentage of breast cancer detected at stage I and II was 61%, another 27% with locally advanced cancer and 11% with late stage metastatic cancer. From the total, 28% are human epidermal growth factor receptor 2 (HER2) positive and access to targeted therapy (trastuzumab) was very limited; only 19% of eligible patients could be treated. Aim: To determine the incremental cost-effectiveness ratio (ICER) between chemotherapy plus trastuzumab and chemotherapy alone as adjuvant treatment of early breast cancer from Malaysian perspective. Methods: A Markov cohort simulation was developed using Microsoft Excel Workbook 2007 to estimate the cost-utility of adjuvant trastuzumab compared with chemotherapy alone for treatment of early breast cancer with HER2 positive status. Two adjuvant treatment strategies were evaluated: 1) chemotherapy plus trastuzumab and 2) chemotherapy alone as adjuvant treatment. This Markov model was projected to lifetime horizon. All costs and outcomes were discounted at 3% and the cost-effectiveness result was expressed in ICER. One-way sensitivity analysis was performed to address the uncertainty. Results: The base case analysis indicated that 1-year adjuvant trastuzumab treatment generates a deterministic ICER of RM 83,544.59 per QALY gained. Over the lifetime, there is a marginal cost increase of RM 85,659.10 and a marginal benefit of 1.025 QALYs per patient when trastuzumab is added to standard chemotherapy compared with no trastuzumab strategy. Based on one-way sensitivity analysis, these components have shown to be a sensitive parameter for ICER determination: discount rate, disease-free state utility, route of trastuzumab administration and cost of trastuzumab. Conclusion: Addition of 1-year treatment with trastuzumab on top of standard adjuvant chemotherapy is considered as a cost-effective strategy for early breast cancer with HER2 positive, yielding an ICER of RM 83,544.59 per QALY gained, which is within the suggested value of cost-effectiveness threshold by WHO (1-3 times GDP per capita). However, if suggested threshold for Malaysia is taken into consideration, this treatment may not be a cost-effective strategy.

scholarly journals Optimum duration of adjuvant trastuzumab in treatment of human epidermal growth factor receptor-2 positive early breast cancer: protocol for a network meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e035802
Author(s):  
Qiancheng Hu ◽  
Xin Wang ◽  
Ye Chen ◽  
Xiaofen Li ◽  
Ting Luo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Early Breast Cancer ◽  
Meta Analysis ◽  
Growth Factor Receptor ◽  
Her2 Positive ◽  
Human Epidermal Growth Factor ◽  
Epidermal Growth

IntroductionControversy regarding optimum duration of trastuzumab treatment remains in patients with human epidermal growth factor receptor-2 (HER2) positive early breast cancer. The objective of applying network meta-analysis (NMA) is to integrate existing evidence based on direct and indirect comparisons of efficacy and safety, and then to determine the duration of trastuzumab treatments with the greatest impact on therapeutic outcomes in HER2-positive early breast cancers.Methods and analysisElectronic searching of trastuzumab treatments for early breast cancer by titles and abstracts will be conducted for the period from inception to 16 June 2019 in PubMed, Cochrane Library, Embase and ClinicalTrils.gov, as well as the annual meetings of San Antonio Breast Cancer Symposium (SABCS), European Society of Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) online archives. The outcomes of interest are overall survival, disease-free survival, acceptability, cardiotoxicities and grade 3 to 4 non-haematological toxicities. Two independent reviewers will screen and extract eligible data based on the inclusion and exclusion criteria, and then assess the risk of bias and evidence quality of individual studies using Cochrane Collaboration’s tool and Grades of Recommendation, Assessment, Development and Evaluation (GRADE). The heterogeneity, transitivity and inconsistency of NMA will be evaluated. In addition, we will perform subgroup and sensitivity analyses to assess the robustness and reliability of findings in our NMA.Ethics and disseminationEthics approval is not required for our NMA. Findings from our NMA will be submitted as peer-reviewed journal manuscripts and international conference reports.Trial registration numberCRD42019139109.

Cost-effectiveness of six months versus 1-year adjuvant trastuzumab in HER2 positive early breast cancer in Egypt

2020 ◽  
Vol 23 (6) ◽  
pp. 575-580
Author(s):  
Gihan Hamdy Elsisi ◽  
Yousery Nada ◽  
Noha Rashad ◽  
João Carapinha ◽  
Ahmad O. Noor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Early Breast Cancer ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab

scholarly journals Real-World Setting Cost-Effectiveness Analysis Comparing Three Therapeutic Schemes of One-Year Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer from the Cyprus NHS Payer Perspective

2020 ◽  
Vol 17 (12) ◽  
pp. 4339
Author(s):  
Savvas S. Ioannou ◽  
Yiola Marcou ◽  
Eleni Kakouri ◽  
Michael A. Talias
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Early Breast Cancer ◽  
Real World ◽  
Cost Effective ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Lifetime Horizon ◽  
Effectiveness Analysis ◽  
One Year

Introduction: This study is one of the first real-world cost-effectiveness analyses of one-year adjuvant trastuzumab used in HER2-positive early female breast cancer in comparison to chemotherapy alone. It is just the second one in Europe, the first one in Cyprus, and the fourth one worldwide ever carried out using real-world data. Methods: Using a Markov model (four health states), a cost-effectiveness analysis was carried out both over 20 years and for a lifetime horizon. The sampling method used in this study was the randomized sampling of 900 women. Results: The findings for the 20-year horizon showed that all trastuzumab arms were more cost-effective, with a willingness-to-pay threshold of only €60,000 per quality-adjusted life year (QALY) [incremental cost-effectiveness ratios (ICER): €40,436.10/QALY]. For the lifetime horizon, with thresholds of €20,000, €40,000, and €60,000/QALY, all trastuzumab arms were found to be more cost-effective (ICER: €17,753.85/QALY). Moreover, for the 20-year and the lifetime horizons, with thresholds of €20,000/QALY, €40,000/QALY, and €60,000/QALY, the most cost-effective of the three subgroups (anthracyclines and then trastuzumab, no anthracyclines and then trastuzumab, and anthracyclines, taxanes, and trastuzumab) was that of anthracyclines and then trastuzumab (ICER: €18,301.55/QALY and €8954.97/QALY, respectively). Conclusions: The study revealed that adjuvant trastuzumab for one year in female HER2-positive early breast cancer can be considered cost-effective.

scholarly journals Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer

2016 ◽  
Vol 34 (9) ◽  
pp. 902-909 ◽  
Author(s):  
Ben Y. Durkee ◽  
Yushen Qian ◽  
Erqi L. Pollom ◽  
Martin T. King ◽  
Sara A. Dudley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Sensitivity Analysis ◽  
Epidermal Growth Factor Receptor ◽  
Metastatic Breast Cancer ◽  
Cost Effectiveness ◽  
Growth Factor Receptor ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Life Years ◽  
Epidermal Growth

Purpose The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) –overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab. Patient and Methods We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions. Results Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.81 life-years gained, or 0.62 QALYs, at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of $100,000 per QALY gained. Conclusion THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States.

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