Author(s) : Francis Fagnani, Xavier Colin, Patrick Arveux, Bruno Coudert, Jean-Louis Misset , Cemka Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, Centre Georges-François-Leclerc, 1, rue du Professeur-Marion, BP77980, 21079 Dijon, Service d’oncologie médicale, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris.
Summary : Trastuzumab (Herceptin
®), a recombinant, humanised, monoclonal-antibody that targets human epidermal growth factor receptor 2 (HER2), has been approved as an adjuvant therapy for HER2-positive early breast cancer. The aim of this study was to assess the incremental cost-effectiveness ratio of this treatment compared with adjuvant therapy alone in the French setting. A cost-effectiveness analysis was performed using a Markov state transition model. The transition probabilities were estimated from the interim results of the Hera trial. Unit costs data were mainly estimated in a French Oncology Center (Georges-François Leclerc, Dijon). The model estimated that overall mean survival of patients treated with trastuzumab was 20.08 years versus 16.23 in the observation group (3.85 life-years gained). For 1 000 patients with a 10-year follow-up, an adjuvant therapy with trastuzumab would avoid 49.7 loco-regional recurrences, 179.5 distant recurrences and 133.4 deaths. The incremental discounted cost of trastuzumab therapy over a lifetime horizon was estimated at 27594 € per patient in association with a discounted gain of 2.27 life-years. In accordance with the techniques of economical evaluation, the utilization of trastuzumab as an adjuvant therapy in patients with early HER2 positive breast cancer improves patient survival with an acceptable cost-effectiveness ratio in the French setting (incremental cost-effectiveness ratio of €12,148/LYG).
Keywords : breast cancer, trastuzumab, HER2, adjuvant therapy, cost-effectiveness
Pictures
Figure 1 Architecture du modèle.
Figure 2 Impact d’une variation de ± 10 %
des principaux paramètres de coûts sur le ratio C/E (ratio exprimé
en coût/Qaly, coûts et bénéfices actualisés à 3 %).
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