title: An economic evaluation of trastuzumab as adjuvant treatment of early HER2-positive breast cancer patients in Colombia.
abstract: OBJECTIVE
  Trastuzumab (Herceptin), a recombinant, humanized, monoclonal antibody targeting HER2 is well established as an effective treatment for HER2-positive breast cancer. Evidence from developed countries showed that trastuzumab was cost-effective; but there are few evidences in developing countries. This study assesses the cost-effectiveness of adjuvant trastuzumab treatment in Colombia.
  
  
  METHODS
  A Markov health-state transition model was built to estimate clinical and economic outcomes in HER2-positive breast cancer with or without 12 months trastuzumab adjuvant chemotherapy over a lifetime perspective with annual transition cycles. The model incorporated five health states (diseasefree, local recurrence, distant recurrence, cardiac failure, and death). Baseline event rates and 3-year hazard ratio (HR=0.51, IC 95% 0.44-0.59; p<0.0001) were derived from 4-year follow up of the N9831 and NSABP B-31 trial. Costs and utility weights were obtained from the literature and were discounted by 5% annually.
  
  
  RESULTS
  The model showed that the utilization of adjuvant trastuzumab treatment in early breast cancer can prolong 0.80 quality-adjusted life-years (QALY), compared with standard chemotherapy, an incremental cost-effectiveness ratio (ICER) of US$ 71,491 per QALY gained.
  
  
  CONCLUSIONS
  The results suggest that 1-year adjuvant Trastuzumab treatment is not cost-effective in Colombia, using the definition of WHO cost-effectiveness threshold of 3 times GDP per capita.
authors.affiliation: Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
authors.forename: Jefferson Antonio
authors.initials: JA
authors.lastname: Buendía
authors.affiliation: Escuela de Medicina, Universidad de La Frontera, Temuco, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vallejos
authors.affiliation: Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Pichón-Rivière
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003105:Colombia; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab