A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in HER2-Positive Early Breast Cancer / 中国药学杂志

ABSTRACT

OBJECTIVE: To advocate Patient Assistant Program Projects (PAP Projects) decision-making, this study assesses the long-term cost-effectiveness of 1-year adjuvant trastuzumab therapy for women with human epidermal growth factor receptor 2 (HER2) positive early breast cancer. METHODS: A Markov model tracked yearly patients' transitions between five health states. The cycle length was 1 year and the sum was 45. From the perspective of the China health insurance system, the direct medical cost was estimated based on a survey of clinical expert panels. A discounting rate of 3% was used to discount direct medical cost and health outcomes. Utility and transition probabilities were retrieved from the HERA trial and literature. To estimate the direct medical cost, a survey of clinical expert panels was conducted. The cost of trastuzumab and HER2 test based on Roche. The key factor of the model was realized by one-way sensitivity analysis. The result of a probability sensitivity analysis conducted by Monte Carlo simulation was expressed as an incremental cost-effectiveness scatter plot. RESULTS: Without PAP Projects in Guangzhou, the adjuvant trastuzumab treatment prolonged 1.79 QALYs when the cost increased ¥53 301 and the Incremental cost-effectiveness ratio (CER) was ¥29 731/QALY, which is cost-effective based on Guangzhou's per capita GDP in 2015. With PAP Projects, the adjuvant trastuzumab treatment was totally cost-effectiveness. The sensitivity analysis demonstrated that the model was moderate. CONCLUSION: One year adjuvant trastuzumab treatment is a cost-effective therapy for patients with HER-2 positive breast cancer. With PAP Projects in Guangzhou, the adjuvant trastuzumab treatment is projected to be associated with improved QALYs and reduces direct medical costs, compared with the standard chemotherapy, represents a dominant treatment option among patients with HER2-Positive Early Breast Cancer. PAP Projects in Guangzhou should be persisted and spread in China.