title: Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer.
abstract: BACKGROUND
  Evidence from randomized controlled trials (RCTs) has shown a significant survival advantage of trastuzumab. Although extant work in developed countries examined economic evaluation of trastuzumab in adjuvant treatment for early breast cancer based on the 1-year treatment, there is uncertainty about cost-effectiveness of trastuzumab in the Adjuvant Treatment of early breast cancer in developing countries. This study aimed to estimate cost-effectiveness of adjuvant trastuzumab therapy compared to AC-T regimen in early breast cancer in Iran.
  
  
  METHODS
  A cost-effectiveness analysis was performed using a Markov model to estimate outcomes and costs over a 20-year time period using a cohort of women with HER2 positive early breast cancer, treated with or without 12 months trastuzumab adjuvant chemotherapy. Transition probabilities were derived mainly from the BCIRG006 trial. Costs were estimated from the perspective of the Iranian health care system. Both costs and outcomes were discounted by 3%. One-way sensitivity analysis was undertaken to assess the associated uncertainties in the expected output measures.
  
  
  RESULTS
  On the basis of BCIRG006 trial, our model showed that adjuvant trastuzumab treatment in early breast cancer, yield 0.87 quality-adjusted life-years (QALY) compared with AC-T regimen. Adjuvant trastuzumab treatment yielded an incremental cost-effectiveness ratio (ICER) of US$ 51302 per QALY.
  
  
  CONCLUSIONS
  By using threshold of 3 times GDP per capita, as per World Health Organization (WHO) recommendation, 12 months trastuzumab adjuvant chemotherapy is not a cost-effective therapy for patients with HER2-positive breast cancer in Iran.
authors.affiliation: Department. of Health Economics, School of Health management and information science, Iran University of Medical Sciences, Tehran, Iran. a.abutorabi@yahoo.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Aboutorabi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hadian
authors.forename: Hossein
authors.initials: H
authors.lastname: Ghaderi
authors.forename: Masoud
authors.initials: M
authors.lastname: Salehi
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghiasipour
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000191:economics; D005260:Female; D006801:Humans; D007492:Iran; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab