title: The real-world cost-effectiveness of adjuvant trastuzumab in HER-2/neu-positive early breast cancer in Taiwan.
abstract: BACKGROUND
  Trastuzumab was considered a cost-effective adjuvant treatment for HER 2-positive early breast cancer. Since 2010, the Taiwanese National Health Insurance (NHI) has started to reimburse for 1-year adjuvant treatment. This study aims to provide an updated cost-effectiveness analysis from the NHI perspective, which explores assumptions about long-term cardiac toxicity and treatment benefit of 1-year adjuvant treatment sequentially after chemotherapy.
  
  
  METHODS
  A Markov model was used to evaluate the cost-effectiveness of 1-year adjuvant trastuzumab for HER-2/neu positive early breast cancer over a 20-year life-time horizon. A probability sensitivity analysis using Monte Carlo simulation was performed to characterize uncertainties in the expected outcomes, which are expressed as an incremental costs effectiveness ratio (ICER, cost/QALY). A willingness-to-pay threshold of 3-times the per capita gross domestic product was adopted according to the WHO definition. The Taiwan per capita gross domestic product in 2015 was US$22,355; thus, a threshold was considered as NT$2,011,950 (US$67 065, 1USD =30 NTD in 2015).
  
  
  RESULTS
  The model showed that adjuvant trastuzumab treatment in HER-2/neu positive early breast cancer yielded 1.631 quality-adjusted life-years (QALY) compared with no trastuzumab treatment. The ICER was US $51,863 per QALY gained in the base-case scenario. The Monte Carlo simulation by varying all variables simultaneously demonstrated that the probability of cost-effectiveness at the willingness-to-pay threshold of US$67,065 was 50% for 1-year adjuvant trastuzumab.
  
  
  CONCLUSIONS
  From this real-world study, 1-year adjuvant trastuzumab treatment is likely to be a cost-effective therapy for patients with HER-2 positive breast cancer at the willingness-to-pay threshold of 3-times GDP per capita in Taiwan.
authors.affiliation: a Institute of Hospital and Health Care Administration, National Yang-Ming University , Taipei , Taiwan ;
authors.forename: Hui-Chu
authors.initials: HC
authors.lastname: Lang
authors.affiliation: b Novotech Clinical Research Taiwan PTY LTD , Taipei City , Taiwan ;
authors.forename: Hsiao-Wei
authors.initials: HW
authors.lastname: Chen
authors.affiliation: c Taipei Veterans General Hospital and National Yang-Ming University School of Medicine , Taipei , Taiwan ;
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.affiliation: d Department of Pharmacy , An-Nan Hospital, China Medical University , Tainan , Taiwan.
authors.forename: Agnes L F
authors.initials: AL
authors.lastname: Chan
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008875:Middle Aged; D009010:Monte Carlo Method; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000302:isolation & purification*; D013624:Taiwan; D000068878:Trastuzumab / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Early breast cancer; HER2-positive; Trastuzumab