Cost and cost-effectiveness of adjuvant trastuzumab in the real world setting: A study of the Southeast Netherlands Breast Cancer Consortium.

Shanly C Seferina,Vivianne C.G Tjan Heijnen,Franchette Van Den Berkmortel,Maaike De Boer,Agnès J Van De Wouw,Adri C Voogd,M Wouter Dercksen,Roel J.W Van Kampen,Manuela A Joore,Bram L.T Ramaekers

doi:10.18632/oncotarget.16985

Abstract

BackgroundWe assessed the real world costs and cost-effectiveness of the addition of trastuzumab in HER2 positive early breast cancer compared to chemotherapy alone in the Dutch daily practice as opposed to the results based on trial data and based on a subset of patients that were treated according to the guidelines.Patients and MethodsIn a cohort study, we included all patients with stage I-III invasive breast cancer treated with curative intent in 5 Dutch hospitals between 2005 and 2007 (n=2684).We assessed three scenarios: a real-world scenario, a trial scenario and a guideline scenario, with costs and effectiveness based on either the cohort study, the published trials or the guidelines. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were constructed.ResultsCosts were €243,216 and €239,657 for trastuzumab and no trastuzumab for the real world scenario, €224,443 and €218,948 for the guideline scenario and €253,666 and €265,116 for the trial scenario. The QALYs were 0.827, 0.861, 0.993 for the real world, guideline and trial scenario. The corresponding ICERs were €4,304, €6,382 and dominance, respectively. CEACs showed that the probability that trastuzumab is cost-effective is ≥99% in each scenario.ConclusionAdjuvant trastuzumab in the real world can be considered cost-effective.

Highlights

In the Netherlands, the use of trastuzumab for the adjuvant treatment of patients with HER2-positive early breast cancer was estimated to be €5,828 per quality adjusted life year (QALY) gained
These studies typically found that adjuvant trastuzumab treatment has an acceptable cost-effectiveness ratio. [2,3,4,5,6,7] in most cases estimates of resource use were based on small datasets or even expert opinion
In the real world scenario and the guideline scenario the trastuzumab treated patient group proved to be more expensive than the group of patients treated with chemotherapy alone

Summary

Patients and Methods

We included all patients with stage I-III invasive breast cancer treated with curative intent in 5 Dutch hospitals between 2005 and 2007 (n=2684).We assessed three scenarios: a real-world scenario, a trial scenario and a guideline scenario, with costs and effectiveness based on either the cohort study, the published trials or the guidelines. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were constructed

Results

INTRODUCTION

RESULTS

DISCUSSION