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Journal of Clinical Oncology, Vol 25, No 6 (February 20), 2007: pp. 625-633 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.06.4220 Cost Effectiveness of Adjuvant Trastuzumab in Human Epidermal Growth Factor Receptor 2Positive Breast Cancer
From the Azienda Ospedaliera della Provincia di Pavia, Divisione di Medicina Interna, Ospedale Civile, Casorate Primo; and Laboratorio di Epidemiologia Clinica, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico S Matteo, Pavia, Italy Address reprint requests to Nicola Lucio Liberato, MD, Divisione di Medicina Interna, Ospedale Civile "C. Mira", 27022 Casorate Primo, Pavia, Italy; e-mail: lucio_liberato{at}ospedali.pavia.it PURPOSE: To evaluate the cost-effectiveness of 12-month adjuvant trastuzumab therapy in women with high-risk human epidermal growth factor receptor 2 (HER2) positive early breast cancer. METHODS: A Markov model tracked quarterly patients transitions between five health states: disease free, local relapse, disease free after local relapse, metastatic disease, and death. Patients were allowed to incur symptomatic or asymptomatic transient cardiac dysfunction during trastuzumab administration. Probabilities were derived mainly from the combined report of the National Surgical Adjuvant Breast and Bowel Project B-31 and the North Central Cancer Treatment Group N9831 trials (95% node positive) and a meta-analysis by the Early Breast Cancer Trialists Collaborative Group. Costs were estimated from the perspective of the Italian and US health care systems. The analysis was run during a 15-year time horizon. A 3% yearly discount rate was applied to both costs and life-years. Second-order Monte-Carlo and probabilistic sensitivity analyses were performed.
RESULTS: Adjuvant trastuzumab increases life expectancy by 1.54 (1.18 discounted) quality-adjusted life-years (QALYs). At a cost of CONCLUSION: In a long-term horizon, adjuvant trastuzumab is a cost-effective therapy for patients with HER2-positive, high-risk, early breast cancer. Authors disclosures of potential conflicts of interest and author contributions are found at the end of this article. Related Editorial
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Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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