Trastuzumab in early stage breast cancer: a cost-effectiveness analysis for Belgium.
OBJECTIVE
Although trastuzumab is traditionally used in metastatic breast cancer treatment, studies reported on the efficacy and safety of trastuzumab in adjuvant setting for the treatment of early stage breast cancer in HER2+ tumors. We estimated the cost-effectiveness and budget impact of reimbursing trastuzumab in this indication from a payer's perspective.


METHODS
We constructed a health economic model. Long-term consequences of preventing patients to progress to metastatic breast cancer and side effects such as congestive heart failure were taken into account. Uncertainty was handled applying probabilistic modeling and through probabilistic sensitivity analyses.


RESULTS
In the HERA scenario, applying an arbitrary threshold of euro30000 per life-year gained, early stage breast cancer treatment with trastuzumab is cost-effective for 9 out of 15 analyzed subgroups (according to age and stage). In contrast, treatment according to the FinHer scenario is cost-effective in 14 subgroups. Furthermore, the FinHer regimen is most of the times cost saving with an average incremental cost of euro668, euro-1045, and euro-6869 for respectively stages I, II and III breast cancer patients whereas the HERA regimen is never cost saving due to the higher initial treatment costs.


CONCLUSIONS
The model shows better cost-effectiveness for the 9-week initial treatment (FinHer) compared to no trastuzumab treatment than for the 1-year post-chemotherapy treatment (HERA). Both from a medical and an economic point of view, the 9-week initial treatment regimen with trastuzumab shows promising results and justifies the initiation of a large comparative trial with a 1-year regimen.
Neyt
Mattias
M
Belgian Health Care Knowledge Centre (KCE), Wetstraat 62, 1040 Brussels, Belgium. mattias.neyt@kce.fgov.be
Huybrechts
Michel
M
Hulstaert
Frank
F
Vrijens
France
F
Ramaekers
Dirk
D
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001530:Belgium; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000235:genetics; D002017:Budgets; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data*; D005260:Female; D018734:Genes, erbB-2; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D017059:Models, Econometric; D009313:National Health Programs; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000627:therapeutic use; D000068878:Trastuzumab; D026712:Value of Life / Q000191:economics
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab