title: [Clinical and economic issues in adjuvant chemotherapy for HER-2 positive breast cancer].
abstract: OBJECTIVE
  To examine efficacy figures and drug expenditure for adjuvant chemotherapy in human epidermal growth factor receptor 2 (HER-2) positive breast cancer, in the Brazilian supplemental health insurance market.
  
  
  METHODS
  We obtained efficacy data (disease free survival at 3-years) and drug cost estimate for current adjuvant strategies in HER-2 positive breast cancer: Finland Herceptin (FinHER), National Surgical Adjuvant Breast and Bowel Project (NSAPB-31), North Central Cancer Treatment Group (N9831), Herceptin Adjuvant (HERA) and Breast Cancer International Research Group (BCIRG-006). We estimated clinical impact measures--number needed to treat (NNT) and absolute risk reduction (ARR)--and total drug cost by protocol to avoid one single cancer recurrence.
  
  
  RESULTS
  The largest ARR was 11.7% (95% CI: 2.2% to 21.2%) in the FinHER study, and the smallest in the nonanthracycline arm of the BCIRG trial, 4.9% (95% CI: 1.8% to 8.1%). The NNT was 8 (95% CI: 3 to 28) in the FinHER, 8 (95% CI: 7 to 11) in the NSABP-31/N9831, 12 (95% CI: 9 to 18) in the HERA, 14 (95% CI: 11 to 24) in the BCIRG/Anthracycline, and 17 (CI 95% CI: 12 to 34) in the BCIRG/Nonanthracycline. Drug cost to avoid one single cancer recurrence would be R$ 418,285.44 with the FinHER regimen, R$ 1,716,789.44 with the NSABP-31/N9831, R$ 2,481,891.58 with the HERA, R$ 2,963,634.62 with the BCIRG/Anthracycline, and R$ 3,930,520.43 with the BCIRG/Nonanthracycline (exchange rate: R$ 1.00=USD 0.56).
  
  
  CONCLUSIONS
  From an economic viewpoint, four to seven times more patients could benefit by using a short-course of trastuzumab at the initial adjuvant chemotherapy cycles (FinHER regimen) than by the prolonged trastuzumab administration as used in other adjuvant schedules.
authors.affiliation: PLANSERV, Estado da Bahia, Salvador, BA. sandro.martins@gmail.com
authors.forename: Sandro José
authors.initials: SJ
authors.lastname: Martins
authors.forename: Crystina Aoki
authors.initials: CA
authors.lastname: Yamamoto
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000191:economics; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D066246:ErbB Receptors; D005260:Female; D006801:Humans; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab