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

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  • William Leung
  • Giorgi Kvizhinadze
  • Nisha Nair
  • Tony Blakely

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?:

Suggested Citation

  • William Leung & Giorgi Kvizhinadze & Nisha Nair & Tony Blakely, 2016. "Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis," PLOS Medicine, Public Library of Science, vol. 13(8), pages 1-19, August.
    • Handle: RePEc:plo:pmed00:1002067
    DOI: 10.1371/journal.pmed.1002067
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    Cited by:

    1. Yizhe Xu & Tom H. Greene & Adam P. Bress & Brian C. Sauer & Brandon K. Bellows & Yue Zhang & William S. Weintraub & Andrew E. Moran & Jincheng Shen, 2022. "Estimating the optimal individualized treatment rule from a cost‐effectiveness perspective," Biometrics, The International Biometric Society, vol. 78(1), pages 337-351, March.
    2. Michelle Tew & Philip Clarke & Karin Thursky & Kim Dalziel, 2019. "Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients," PharmacoEconomics, Springer, vol. 37(7), pages 931-941, July.
    3. Savvas S. Ioannou & Yiola Marcou & Eleni Kakouri & Michael A. Talias, 2020. "Real-World Setting Cost-Effectiveness Analysis Comparing Three Therapeutic Schemes of One-Year Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer from the Cyprus NHS Payer Perspective," IJERPH, MDPI, vol. 17(12), pages 1-20, June.

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