Use of the monoclonal antibody anti-HER2 trastuzumab in the treatment of metastatic breast cancer: a cost-effectiveness analysis.
BACKGROUND
This open controlled prospective study aimed at evaluating the medical and economical impact of first line chemotherapy for metastatic breast cancer (MBC).


METHODS
Two groups of HER +++ MBC patients were compared: 26 were treated by a combination of trastuzumab and paclitaxel in 4 "prescriber" centers (group A) and 19 patients were treated by any chemotherapy without addition of trastuzumab, in 6 control centers (group B). The cost of chemotherapy and related hospitalizations was taken into account during the first 8 cycles.


RESULTS
Forty-five patients, mean age 51 years have been included. The objective response rate was significantly higher in group A (42% vs. 6%, P = 0.036). The median overall survival was 17 months longer in the group A (29 vs. 12 months). The median progression free survival rate was 12.2 months longer in the group A (19 vs. 7 months). The 1-year survival rate was 85% in the group A and 47% in the group B. The mean overall care cost was 33.271 euro per patient in group A versus 11.191 euro per patient in group B. The additional cost per saved year of life expressed as the incremental cost-effectiveness ratio is 15.370 euro 2002.


CONCLUSIONS
The related additional cost seems affordable for an European health care system and justifies the recommendation for its use in the subpopulation overexpressing HER2.
Département d'Information Médicale, Unit of Medico-Economic Evaluation, Hospices Civils de Lyon, Lyon, France.
Bénédicte
B
Poncet
Thomas
T
Bachelot
Cyrille
C
Colin
Christell
C
Ganne
Isabelle
I
Jaisson-Hot
Hubert
H
Orfeuvre
Pierre-Yves
PY
Peaud
Jean-Philippe
JP
Jacquin
Bruno
B
Salles
Jean-Dominique
JD
Tigaud
Isabelle
I
Mechin-Cretinon
François
F
Marechal
Cécile
C
Fournel
Véronique
V
Trillet-Lenoir
Véronique Trillet
VT
Lenoir
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000191:economics; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000276:immunology / Q000378:metabolism; D012878:Skin Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D015996:Survival Rate; D000068878:Trastuzumab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab