Advanced Search
MyIDEAS: Login

Updated Cost-Effectiveness Analysis of Trastuzumab for Early Breast Cancer: A UK Perspective Considering Duration of Benefit, Long-Term Toxicity and Pattern of Recurrence

Contents:

Author Info

  • Peter S. Hall

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK)

  • Claire Hulme

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK)

  • Christopher McCabe

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK)

  • Yemi Oluboyede

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK)

  • Jeff Round

    (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK)

  • David A. Cameron

    (Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK)

Abstract

Background: Trastuzumab has significantly improved survival outcomes for women with Human Epidermal growth factor Receptor 2 (HER2)-positive early breast cancer. Trastuzumab was established as a cost-effective adjuvant treatment in 2006. We present an updated cost-effectiveness analysis from the UK perspective, which explores assumptions about the duration of benefit from treatment, pattern of metastatic recurrence and long-term cardiac toxicity. Objective: The objective of this study was to calculate, from the UK NHS perspective, expected costs (year 2008 values) and benefits over the lifetime of an average cohort of women with HER2-positive early breast cancer treated with or without 1 year of adjuvant trastuzumab sequentially after chemotherapy. Methods: A cost-utility analysis was performed using a discrete-state time-dependent semi-Markov model. Probabilistic sensitivity analysis was used to characterize uncertainty around expected outcomes. Value-of-information (VOI) analysis was used to identify areas of priority for further research. Results: The cost-effectiveness estimates were highly sensitive to the estimated duration of treatment benefit. Trastuzumab remained a cost-effective treatment strategy at a willingness-to-pay threshold of £30 000 per QALY provided the duration of benefit was more than 3.6 years from treatment initiation, assuming the hazard ratio for disease-free survival was 0.63. An increasing proportion of brain metastases with trastuzumab produced a small change towards worse cost effectiveness. Long-term cardiac toxicity needed to rise to high levels to affect overall life expectancy and cost effectiveness. VOI analysis placed highest value on research into the duration of treatment benefit. The relationships between progression-free survival and overall survival and the costs of cancer recurrence were also important. Conclusion: The cost effectiveness of adjuvant trastuzumab remains uncertain and dependent on assumptions regarding its clinical effect. Uncertainty around cost effectiveness could be reduced by further research into the duration of treatment effect, particularly in subgroups where this may be shorter. Long-term follow-up is warranted and methods to accurately measure duration of treatment effect and late toxicities should be developed for future adjuvant drug studies.

Download Info

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
File URL: http://PharmacoEconomics.adisonline.com/pt/re/pec/pdfhandler.00019053-201129050-00006.pdf
Download Restriction: Pay per view

File URL: http://PharmacoEconomics.adisonline.com/pt/re/pec/fulltext.00019053-201129050-00006.htm
Download Restriction: Pay per view

As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

Bibliographic Info

Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

Volume (Year): 29 (2011)
Issue (Month): 5 ()
Pages: 415-432

as in new window
Handle: RePEc:wkh:phecon:v:29:y:2011:i:5:p:415-432

Contact details of provider:
Web page: http://pharmacoeconomics.adisonline.com/

Related research

Keywords: Cost-utility; Early-breast-cancer; treatment; Trastuzumab; therapeutic use.;

Find related papers by JEL classification:

References

No references listed on IDEAS
You can help add them by filling out this form.

Citations

Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
as in new window

Cited by:
  1. Christopher McCabe & Richard Edlin & Peter Hall, 2013. "Navigating Time and Uncertainty in Health Technology Appraisal: Would a Map Help?," PharmacoEconomics, Springer, vol. 31(9), pages 731-737, September.
  2. Christopher McCabe & Richard Edlin & Peter Hall & Klemens Wallner, 2013. "Leasing health technologies- an affordable and effective reimbursement strategy for innovative technologies?," Working Papers 1302, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds.
  3. Lotte Steuten & Gijs Wetering & Karin Groothuis-Oudshoorn & Valesca Retèl, 2013. "A Systematic and Critical Review of the Evolving Methods and Applications of Value of Information in Academia and Practice," PharmacoEconomics, Springer, vol. 31(1), pages 25-48, January.

Lists

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

Statistics

Access and download statistics

Corrections

When requesting a correction, please mention this item's handle: RePEc:wkh:phecon:v:29:y:2011:i:5:p:415-432. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dave Dustin).

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.