Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis

William Leung, Giorgi Kvizhinadze, Nisha Nair and Tony Blakely

PLOS Medicine, 2016, vol. 13, issue 8, 1-19

Abstract: Background: The anti–human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab’s high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone receptor (PR) status, which has previously been unexplored, to assist prioritisation. Methods and Findings: A cost-utility analysis was performed using a Markov macro-simulation model, with a lifetime horizon, comparing a 12-mo regimen of trastuzumab with chemotherapy alone using the latest (2014) effectiveness measures from landmark randomised trials. A New Zealand (NZ) health system perspective was adopted, employing high-quality national administrative data. Conclusions: This study highlights how cost-effectiveness can vary greatly by heterogeneity in age and hormone receptor subtype. Resource allocation and licensing of subsidised therapies such as trastuzumab should consider demographic and clinical heterogeneity; there is currently a profound disconnect between how funding decisions are made (largely agnostic to heterogeneity) and the principles of personalised medicine. In a Markov simulation using New Zealand health data, William Leung and colleagues assess the age- and subtype-specific cost-effectiveness of trastuzumab with breast cancer chemotherapy.Why Was This Study Done?: What Did the Researchers Do and Find?: What Do These Findings Mean?:

Date: 2016
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1002067

DOI: 10.1371/journal.pmed.1002067

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