title: Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.
abstract: OBJECTIVE
  Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint.
  
  
  METHODS
  The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results.
  
  
  RESULTS
  Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease.
  
  
  CONCLUSIONS
  Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.
authors.affiliation: Department of Social Pharmacy, Center for Pharmaceutical Policy and Economics, University of Kuopio, Kuopio, Finland. timo.purmonen@uef.fi
authors.forename: Timo T
authors.initials: TT
authors.lastname: Purmonen
authors.forename: Päivi K
authors.initials: PK
authors.lastname: Auvinen
authors.forename: Janne A
authors.initials: JA
authors.lastname: Martikainen
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D002017:Budgets; D003198:Computer Simulation; D003365:Costs and Cost Analysis / Q000379:methods; D004470:Economics, Medical; D005260:Female; D005387:Finland; D006767:Hospitals, District / Q000191:economics*; D006801:Humans; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab