title: Societal costs and benefits of treatment with trastuzumab in patients with early HER2neu-overexpressing breast cancer in Singapore.
abstract: BACKGROUND
  Trastuzumab has revolutionized the way we treat early Her2Neu-positive breast cancer, as it significantly improves disease-free and overall survival. Little is known about the societal costs and benefits of treatment with trastuzumab in the adjuvant setting in Southeast Asia.
  
  
  METHODS
  Societal costs (benefits) were estimated as the sum of direct and indirect costs minus benefits in the base case. Direct costs were derived from 4 treatment centers in Singapore (2 private and 2 public, comprising 60-70% of all patients with cancer seen in the island-nation); indirect costs were assessed as the loss of productivity caused by the disease or treatment. Benefits to society were based on extra years of productivity, as measured by GNI per capita, resulting from the quality adjusted life-years (QALYs) saved with the use of trastuzumab as determined in the models by Kurian, Liberato and Garrison.
  
  
  RESULTS
  Incremental costs in Singapore, in 2005 US dollars, were $26,971.05. Average Cost per QALY was $19,174.59 (Median: $18,993.70). Costs (benefits) to society ranged from a cost of $79.42 to a benefit of $9,263.06, depending on the model used (Average benefit: $4,375.89, Median $3,944.03). Sensitivity analysis ranged from a cost of $10,685.00 to a Benefit of US$17,298.79
  
  
  CONCLUSIONS
  Treatment with adjuvant trastuzumab is likely to generate net societal economic benefits in Singapore. Nevertheless, the lower range of possible outcomes does not refute the possibility that treatment may actually generate costs. These costs however clearly fall within the usual range of acceptable cost-effectiveness.
authors.affiliation: Department of Medical Oncology, Johns Hopkins Singapore International Medical Centre, Johns Hopkins University School of Medicine, 11 Jalan Tan Tock Seng (Level 1), Singapore, (308433), Republic of Singapore. glopes@imc.jhmi.edu
authors.forename: Gilberto
authors.initials: G
authors.lastname: de Lima Lopes
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* / Q000191:economics* / Q000503:physiopathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007558:Italy; D015233:Models, Statistical; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D012846:Singapore; D000068878:Trastuzumab; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab