Trastuzumab beyond progression: a cost-utility analysis.
BACKGROUND
The continuation of trastuzumab beyond progression in combination with capecitabine as secondary chemotherapy for HER2-positive metastatic breast cancer (MBC) prolongs progression-free survival without a substantial increase in toxicity.


METHODS
A Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Information on response rates and major adverse effects was derived, and transition probabilities were estimated, based on the results of the Breast International Group 03-05 clinical trial. Direct costs were assessed from the perspective of the Swiss health care system.


RESULTS
The addition of trastuzumab to capecitabine is estimated to cost on average an additional of €33,980 and to yield a gain of 0.35 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of €98,329/QALYs gained. Probabilistic sensitivity analysis showed that the willingness-to-pay threshold of €60,000/QALY was reached in 12% of cases.


CONCLUSIONS
The addition of trastuzumab to capecitabine in MBC patients is more expensive than what is typically regarded as cost-effective but falls within the value ranges found for established regimens in the treatment of MBC.
Matter-Walstra
K W
KW
European Center of Pharmaceutical Medicine, University of Basel, Basel; Swiss Group for Clinical Cancer Research (SAKK), Bern. Electronic address: klazien.matter@unibas.ch.
Dedes
K J
KJ
Department of Gynecology.
Schwenkglenks
M
M
European Center of Pharmaceutical Medicine, University of Basel, Basel.
Brauchli
P
P
Swiss Group for Clinical Cancer Research (SAKK), Bern.
Szucs
T D
TD
European Center of Pharmaceutical Medicine, University of Basel, Basel.
Pestalozzi
B C
BC
Department of Oncology, University Hospital of Zurich, Zurich, Switzerland.
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D000069287:Capecitabine; D003362:Cost-Benefit Analysis / Q000191:economics*; D003365:Costs and Cost Analysis; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008207:Lymphatic Metastasis; D008390:Markov Chains; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013997:Time Factors; D000068878:Trastuzumab
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003841:Deoxycytidine; D000069287:Capecitabine; D000068878:Trastuzumab; D005472:Fluorouracil