Cost-effectiveness of adjuvant paclitaxel and trastuzumab for early-stage node-negative, HER2-positive breast cancer

Ali Hajjar, Mehmet A. Ergun, Oguzhan Alagoz*, Murtuza Rampurwala

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Özet

Objectives Adjuvant paclitaxel and trastuzumab has been shown to be an effective regimen with low risk of cancer recurrence and treatment-related toxicities in early-stage node-negative, HER2-positive breast cancer. We investigated the cost-effectiveness of this regimen. Methods A Markov-based microsimulation model with six health states is used to simulate four adjuvant therapy options for women with early-stage node-negative, HER2-positive breast cancer at different age groups. The four treatment arms are 1) adjuvant paclitaxel and trastuzumab (TH), 2) doxorubicin, cyclophosphamide, paclitaxel and trastuzumab (ACTH), 3) docetaxel, carboplatin and trastuzumab (TCH), and 4) no adjuvant trastuzumab (NT). Data from randomized trials were used to estimate treatment efficacy. Societal perspective was used in this cost-effectiveness analysis. Costs were measured in 2016 US dollars (US $) and quality-adjusted life-years (QALYs) was used for health outcomes. Sensitivity analyses were performed to evaluate the impact of uncertainty in parameter estimation. Results We found that 40-year-old women undergoing TH treatment would have an average of 16.17 QALYs for the cost of $178,650 when lifetime horizon is used. Compared to NT, TH has incremental cost-effectiveness ratios ranged from $10,584 (ages 40–49) to $84,981 (age 80+) per additional QALYs. The sensitivity analysis showed that TH is cheaper and leads to higher QALYs compared to both ACTH and TCH for all age groups and time horizons. Conclusions TH is cost-effective for all age groups in the base case scenario and in the sensitivity analysis. In order to reduce the parameter uncertainty, clinical trials with longer follow-up times are needed.

Orijinal dilİngilizce
Makale numarasıe0217778
DergiPLoS ONE
Hacim14
Basın numarası6
DOI'lar
Yayın durumuYayınlandı - Haz 2019
Harici olarak yayınlandıEvet

Bibliyografik not

Publisher Copyright:
Copyright: © 2019 Hajjar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Finansman

This research is supported through grant 2UL1TR000427 from the Clinical and Translational Science Awards (CTSA) Program of the National Center for Research Resources (NCRR) - National Institutes of Health (NIH) to OA and AH.

FinansörlerFinansör numarası
National Institutes of Health
National Center for Research Resources
National Center for Advancing Translational SciencesUL1TR000427
Canadian Thoracic Society2UL1TR000427

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