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Trastuzumab beyond progression: a cost-utility analysis.

K W Matter-Walstra¹, K J Dedes², M Schwenkglenks³

¹European Center of Pharmaceutical Medicine, University of Basel, Basel; Swiss Group for Clinical Cancer Research (SAKK), Bern.

Annals of Oncology : Official Journal of the European Society for Medical Oncology

|May 7, 2010

Summary

Adding trastuzumab to capecitabine for HER2-positive metastatic breast cancer (MBC) improves progression-free survival. While increasing costs, this combination is considered within the value range for established MBC treatments.

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Area of Science:

Oncology
Pharmacoeconomics

Background:

HER2-positive metastatic breast cancer (MBC) treatment often involves continuing trastuzumab beyond progression.
Combination therapy with capecitabine is a strategy to improve outcomes.

Purpose of the Study:

To evaluate the cost-effectiveness of continuing trastuzumab with capecitabine in HER2-positive MBC patients.
To assess the economic impact from a Swiss healthcare system perspective.

Main Methods:

A Markov cohort simulation model was employed.
Data from the Breast International Group 03-05 clinical trial informed response rates, adverse effects, and transition probabilities.
Direct costs were analyzed within the Swiss healthcare system.

Main Results:

The addition of trastuzumab to capecitabine incurs an average additional cost of €33,980.
This strategy yields an estimated gain of 0.35 quality-adjusted life years (QALYs).
The incremental cost-effectiveness ratio (ICER) was calculated at €98,329 per QALY gained, with a 12% probability of reaching the €60,000/QALY threshold.

Conclusions:

Trastuzumab plus capecitabine for MBC is more costly than typically considered cost-effective.
However, the cost-effectiveness falls within the established value range for MBC treatments.