Trastuzumab treatment of early stage breast cancer is cost-effective from the perspective of the Belgian health care authorities.

Trastuzumab (Herceptin, Roche) is a recombinant, humanized monoclonal antibody directed against the neu-HER2 protein, since May 2002 reimbursed in Belgium for the treatment of metastatic HER2+ breast cancer and since June 2007 also in adjuvant therapy of HER2+ early stage breast cancer. The purpose of this study was to estimate the cost-effectiveness from the Belgian health care payer perspective of reimbursing trastuzumab in the Latter indication. A Markov state transition model was designed to adequately capture the natural history and course of disease for early stage breast cancer patients, and to simulate cost and disease progression over a life time perspective. The model estimates differences in outcomes for patients treated with adjuvant trastuzumab during 1 year compared to current therapy, and captures cost consequences and health benefits of trastuzumab treatment. Health benefits were expressed in terms of quality-adjusted life years gained, and future benefits were discounted at 1.5%. Costs were calculated from the perspective of the Belgian authorities' health care budget, and future costs were discounted at 3%. Where relevant, the costs per Markov state were obtained from the IMS Hospital Disease database. Additionally, an expert opinion analysis on resource use during the follow-up of treated early breast cancer patients provided the cost estimates for states with minor or without hospital costs. The incremental cost-effectiveness ratio based on a life time simulation was estimated at Euro 10,315 per quality-adjusted life year gained. It can be concluded that trastuzumab treatment of HER2+ early stage breast cancer patients is cost-effective from the perspective of the Belgian health care authorities.

A health economic model to assess the cost-effectiveness of PEG IFN alpha-2a and ribavirin in patients with mild chronic hepatitis C.

According to the current guidelines, it is advised not to treat patients with mild chronic hepatitis C. However, discussions as to giving immediately a treatment (direct treatment) to these patients have started and the incremental cost-effectiveness ratio (ICER) of such strategy is still unknown. The aim of this study was to estimate, in the health care payer perspective, the ICER of a direct treatment of patients with mild chronic hepatitis C in comparison with the strategy of monitoring these patients and treat them when the disease will progress to the state of moderate chronic hepatitis. The treatment assessed was the current standard treatment composed of pegylated interferon alpha-2a and ribavirin. At the beginning of the study, patients were aged 45. Long-term economic and clinical outcomes over a 30-year period were predicted using a Markov simulation model. Data were obtained from published literature. Monte Carlo simulations were used to determine 95% confidence intervals of results. The ICER of a direct treatment with PEG IFN alpha-2a and ribavirin is 23,046 euro/QALY (CI 95% 3,882 euro-42,392 euro) for genotypes 1-4-5-6 and 4,631 euro/QALY (CI 95% 797 euro-7,881 euro) for genotypes 2-3. Sensitivity analysis shows that it is only in extreme circumstances related to the utilities that the ICER for genotypes 1-4-5-6 is unacceptably high for the society (>50,000 euro). Even though a direct treatment is more expensive, it gives the advantage of curing greater number of patients and of increasing quality-adjusted life-years (QALYs), implying that such strategy is generally cost-effective at a threshold of 50,000 euro/QALY.

A health economic model to assess the long term effects and cost-effectiveness of PEG IFN alpha-2a in hepatitis C virus infected patients.

OBJECTIVES: Chronic Hepatitis C (CHC) is associated with long-term complications. Treating CHC with Pegylated interferon alpha-2a (PEG IFN alpha-2a) improves response rates and may contribute to less morbidity and mortality compared to standard interferon therapy. The objectives of this study were to estimate the long-term clinical consequences of such treatment as well as the resulting cost-effectiveness. RESEARCH DESIGN AND METHODS: A Markov model was developed in order to predict the clinical and economic outcomes over a 25 year period. Three analyses were conducted: 1. for all Hepatitis C Virus (HCV) genotypes where PEG IFN alpha-2a was compared to interferon alpha-2a (IFN alpha-2a) in monotherapy for 48 weeks; 2. for the HCV genotypes 1-4-5-6 comparing PEG IFN alpha-2a with interferon alpha-2b (IFN alpha-2b) both combined with ribavirin 1000/1200 mg for 48 weeks; and 3, where PEG IFN alpha-2a with 800 mg ribavirin was compared to IFN alpha-2b with ribavirin 1000/1200 mg for 24 weeks in genotypes 2 and 3. RESULTS: In analysis one the cost-effectiveness of PEG IFN alpha-2a is 4,569/quality adjusted life year (QALY) gained. In the second analysis, the result was 14,763 euros/QALY, while for the 24 weeks therapy (analysis 3) the result was 903 per QALY gained. In an extensive sensitivity analysis cost-effectiveness was confirmed within reasonable assumptions. CONCLUSIONS: These results suggest that PEG IFN alpha-2a is cost-effective in the management of all CHC patients. Real life evidence about longer term benefits of PEG IFN alpha-2a will be of importance for future decision making.