Abstract
BackgroundBreast cancer is the most common cancer among women in China. Amplification of the Human epidermal growth factor receptor type 2 (HER2) gene is present and overexpressed in 18–20% of breast cancers and historically has been associated with inferior disease-related outcomes. There has been increasing interest in de-escalation of therapy for low-risk disease. This study analyzes the cost-effectiveness of Doxorubicin/ Cyclophosphamide/ Paclitaxel/ Trastuzumab (AC-TH) and Docetaxel/Carboplatin/Trastuzumab(TCH) from payer perspective over a 5 year time horizon.MethodsA half-cycle corrected Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients. Cost data came from studies based on a Chinese hospital. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted.ResultsWe identified 41 breast cancer patients at Hangzhou First People’s Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment.No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients.Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with AC-TH, while the incremental costs were $US13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained.ConclusionsThis study concluded that TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities.
Highlights
Breast cancer is the most common cancer among women in China
Trastuzumab, a humanized monoclonal antibody that targets the extracellular domain of the human epidermal growth factor receptor-2 (HER-2) protein, was found to improve survival in the metastatic disease setting when used in combination with chemotherapy [2]
The effectiveness analysis showed that TH compared with DCT (TCH) was slightly preferred over the ACTH strategy when measured in qualityadjusted life-years (QALYs)
Summary
Breast cancer is the most common cancer among women in China. Breast cancer is one of the most common malignant tumors in women, and its incidence continues to rise. The incidence of breast cancer in China shows an increasing trend year by year [1]. Trastuzumab, a humanized monoclonal antibody that targets the extracellular domain of the HER-2 protein, was found to improve survival in the metastatic disease setting when used in combination with chemotherapy [2]. In a large, randomized study, the addition of trastuzumab to chemotherapy improve the rates of objective response, response duration, and time to disease progression, as well as a 30% improvement in the rate of overall survival among patients with firstline metastatic disease [2]. A significant side effect was cardiac dysfunction, including congestive heart failure,especially when trastuzumab was used in combination with anthracycline-based regimens [2]
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