Author(s)
Tsu-Yi Chao, MD, Director1, Shin-Cheh Chen, MD, Director2, King-Jen Chang, MD, Director3, Hsien-Kun Chang, MD, Attending Physician4, Dar-Ren Chen, MD, Director5, Ming-Feng Hou, MD, Director6, Ruey-Kuen Hsieh, MD, Director7, Wen-Tsung Huang, MD, Attending Physician8, Ling-Ming Tseng, MD, Attending Physician9, Hwei-Chung Wang, MD, Director10, Lily Yang, MS, Pharmacoeconomics Manager11, Alessandro Cirrincione, Msc, International Economic Strategy Leader121Tri-Service General Hospital, Taipei, Taiwan; 2 Chang Guang Memorial Hospital, Taipei Branch, Taipei, Taiwan; 3 National Taiwan University Hospital, Taipei, Taiwan; 4 Chang Guang Memorial Hospital, Linkou Branch, Linkou, Taiwan; 5 Changhua Christian Hospital, Changhua, Taiwan; 6 Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 7 Mackay Memorial Hospital, Taipei, Taiwan; 8 Chimei Medical Center, Tainan, Taiwan; 9 Taipei Veterans General Hospital, Taipei, Taiwan; 10 China Medical University Hospital, Taichung, Taiwan; 11 Roche Products Ltd, Taipei, Taiwan; 12 F.Hoffmann-La Roche Ltd, Basel, Switzerland
OBJECTIVES: Results from the HERA, NSABP B-31, and NCCTG N9831 trails demonstrated a reduction in risk of recurrence by approximately 50% with the addition of trastuzumab to standard adjuvant therapy in early breast cancer (EBC). The objective of this cost-effectiveness analysis (CEA) is to evaluate the long term clinical outcomes and economic impact of one year adjuvant trastuzumab compared to no trastuzumab in addition to standard adjuvant therapy for patients with HER2-positive EBC in Taiwan from the payer's [Bureau of National Health Insurance (BNHI)] perspective. METHODS: A five-state Markov model was developed to estimate the incremental cost and long-term health outcomes in terms of quality-adjusted life years (QALYs) of EBC over a patient's lifetime. Clinical outcomes and disease transition probabilities were derived from the HERA trial. Direct medical costs associated with drugs, trastuzumab administration, and HER2 testing were based on Taiwan's National Health Insurance fee schedule 2007. Medical resource utilizations associated with disease free survival (DFS), recurrence, metastasis, and cardiac side effects were estimated by an expert panel survey conducted among ten oncologists. Population-based utilities were applied to the main health states in the Markov model, while disutilities of cardiac events were obtained from published literature. Benefits and future costs were discounted at annual rate of 3.5%. One-way sensitivity analyses were performed on key model parameters. RESULTS: Compared to standard adjuvant therapy alone, adding trastuzumab to standard treatment increased drugs costs and DFS, however, the incremental costs were offset by reduced costs of recurrence and metastasis. Over a lifetime, one year adjuvant trastuzumab yielded an incremental cost-effectiveness ratio (ICER) of NTD$152,620 (€3,451) per QALY. Adjuvant trastuzumab remained cost-effective under sensitivity testing. CONCLUSION: From the perspective of Taiwan BNHI, this CEA demonstrates that one year adjuvant trastuzumab offers health benefits at a favorable ICER in patients with HER2-positive EBC.
Conference/Value in Health Info
2007-10, ISPOR Europe 2007, Dublin, Ireland
Value in Health, Vol. 10, No. 6 (November/December 2007)
Code
PCN16
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology
