title: Cost-effectiveness analysis of trastuzumab to treat HER2-positive advanced gastric cancer based on the randomised ToGA trial.
abstract: BACKGROUND
  We performed a cost-effectiveness analysis of trastuzumab plus chemotherapy for human epidermal growth factor type-2 (HER2)-positive advanced gastric cancer (GC) based on data obtained from the Trastuzumab for Gastric Cancer (ToGA) trial from a Japanese perspective.
  
  
  METHODS
  The following Japanese and Korean populations of the ToGA trial were analysed to obtain mean overall and progression-free survival times: (1) all HER2-positive populations, (2) immunohistochemical (IHC) 2+/fluorescence in situ hybridisation (FISH)+ or IHC 3+ populations, and (3) IHC 3+ only population. The effect of trastuzumab treatment on mean survival time was estimated by fitting a Weibull parametric function. Costs were calculated from the perspective of health-care payer. Neither costs nor outcomes were discounted because of short life expectancy.
  
  
  RESULTS
  In the base-case analysis, the incremental cost-effectiveness ratio was (1) JPY 12 million (€110,000) per quality-adjusted life year (QALY) gained and JPY 8.9 million (€81,000) per life-year gained (LYG) for all HER2-positive populations, (2) JPY 9.1 million (€83,000) per QALY gained and JPY 6.6 million (€60,000) per LYG for the IHC 2+/FISH+ or IHC 3+ population, and (3) JPY 6.1 million (€55,000) per QALY gained and JPY 4.3 million (€39,000) per LYG for the IHC 3+ population.
  
  
  CONCLUSIONS
  Trastuzumab treatment for IHC 3+ populations is cost effective. Our analysis can find a cost-effective subgroup when advanced GC is treated by trastuzumab.
authors.affiliation: Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan. t.shiroiwa@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Shiroiwa
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.forename: K
authors.initials: K
authors.lastname: Shimozuma
mesh_terms: D061067:Antibodies, Monoclonal, Humanized; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006282:Health Personnel; D006801:Humans; D007564:Japan; D007723:Korea; D008297:Male; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab