Abstract:
BACKGROUND:Recent randomised trials have demonstrated a statistically significant effect of trastuzumab on disease-free survival when used as adjuvant therapy for human epidermal growth factor receptor 2 protein (HER2)-positive resectable early stage breast cancer, with a treatment course lasting either 9 or 52 weeks. However, the cost effectiveness of adjuvant trastuzumab with respect to mortality remains uncertain, especially in an Australian setting. OBJECTIVE:To estimate the cost effectiveness of trastuzumab in Australia, in a cohort of 50-year-old patients with HER2-positive breast cancer over a lifetime, using (i) disease-free survival and cardiotoxicity data from recent randomised trials; (ii) information on long-term survival of patients with treated primary breast cancer; and (iii) costs of treating local and distant relapses and disease from causes other than breast cancer. METHODS:A Markov model consisting of four health states (remission, loco-regional recurrence, metastatic disease and death) was developed. Transition probabilities corresponded to patterns of relapse and metastases seen in recent trials. The model was run until age 100 years to allow calculation of average survival. Outcome measures were life-years and QALYs (calculated using utility weights reported in the literature). The model was calibrated to reflect literature evidence that the risk of breast cancer recurrence following primary treatment diminishes progressively to zero after about 20 years. It was assumed that the morbidity benefit of trastuzumab observed in trials would be present for 5 years but would then diminish progressively to zero after 8 years. Costs (year 2005 values) and benefits were discounted at 3% per annum. RESULTS:For every 1000 patients treated with a 52-week course of trastuzumab, there were 136 fewer breast cancer deaths (relative risk reduction 28%). The incremental cost-effectiveness ratios (ICERs) were Australian dollars ($ A)13 730 per year of life saved (YOLS) and $ A22 793 per QALY. The net incremental cost was $ A56.3 million ($ A414 012/cancer death avoided). Cost effectiveness declined (ICER = $ A27 734/QALY) in older patients (age 65 years at treatment initiation). The ICER was driven mainly by the drug acquisition costs, the assumption of the duration of benefit and the discount rate. Cost offsets from reduced costs of treating recurrent or metastatic breast cancer during follow-up were present but these factors were of less importance according to sensitivity analyses. The 9-week treatment schedule approached economic dominance (ICER = $ A1700/QALY) because of decreased costs, improved relative risk for prevention of metastases and more cancer deaths avoided (196). CONCLUSION:The results suggest that trastuzumab as adjuvant therapy for early breast cancer may be cost effective when given over either 52 or 9 weeks at current acquisition costs in Australia. However, the overall budget impact of the 52-week course is significant, and the 9-week course appears economically attractive.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Millar JA,Millward MJdoi
10.2165/00019053-200725050-00006subject
Has Abstractpub_date
2007-01-01 00:00:00pages
429-42issue
5eissn
1170-7690issn
1179-2027pii
2556journal_volume
25pub_type
杂志文章abstract:BACKGROUND:The apparent decrease in the rate of approval of new molecular entities has provoked extensive discussion and fears that the productivity of biopharmaceutical research and development has severely declined in recent years. OBJECTIVE:To investigate the extent to which traditional measures of innovative outpu...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200624002-00008
更新日期:2006-12-01 00:00:00
abstract::The regulation of pricing and trade for in-patent medicines within the European pharmaceutical sector presents a major challenge. In conditions of large sunk costs and consumers with differential willingness to pay--between different Member States--an efficient way of pricing in-patent medicines is through price discr...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200018001-00008
更新日期:2000-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199304060-00005
更新日期:1993-12-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-018-0677-7
更新日期:2018-12-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200321150-00005
更新日期:2003-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200624110-00002
更新日期:2006-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
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更新日期:2017-12-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11589450-000000000-00000
更新日期:2012-10-01 00:00:00
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doi:10.2165/00019053-200017020-00006
更新日期:2000-02-01 00:00:00
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journal_title:PharmacoEconomics
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doi:10.2165/00019053-200523110-00007
更新日期:2005-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章
doi:10.2165/00019053-199712020-00008
更新日期:1997-08-01 00:00:00
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journal_title:PharmacoEconomics
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doi:10.2165/11590380-000000000-00000
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journal_title:PharmacoEconomics
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doi:10.1007/s40273-017-0553-x
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199405050-00005
更新日期:1994-05-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-012-0015-4
更新日期:2013-02-01 00:00:00
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journal_title:PharmacoEconomics
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doi:10.2165/00019053-200523001-00004
更新日期:2005-01-01 00:00:00
abstract::External genital warts (EGW) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV). Several studies have described the direct and indirect costs of EGW, while others have reported on the burden of EGW in terms of the impact on the quality of life (QOL) of patients. The arrival of...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11591170-000000000-00000
更新日期:2012-01-01 00:00:00
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doi:10.1007/s40273-020-00954-y
更新日期:2020-12-01 00:00:00
abstract::The purpose of this study was to estimate the direct and indirect costs of alcoholism in the Federal Republic of Germany. Direct costs comprised treatment costs, while indirect costs consisted mainly of costs incurred as a result of work time lost, as well as costs related to premature retirement and premature mortali...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199610050-00006
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:A cost-effectiveness analysis of oral capecitabine versus intravenous bolus 5-fluorouracil/l-leucovorin (FU/LV) as adjuvant therapy in patients with stage 3 colon cancer was performed from a Japanese healthcare payer perspective. METHODS:Adjuvant therapy comprised 24 weeks of treatment with either oral capec...
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doi:10.2165/11310110-000000000-00000
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journal_title:PharmacoEconomics
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doi:10.1007/s40273-018-0625-6
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199610020-00009
更新日期:1996-08-01 00:00:00
abstract::The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of golimumab (Schering-Plough/Centocor) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of active and progressive psoriatic arthritis (PsA) in patients who have responded inadequately to ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11595920-000000000-00000
更新日期:2012-04-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199400061-00018
更新日期:1994-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200220050-00002
更新日期:2002-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-015-0289-4
更新日期:2015-10-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 已发布勘误
doi:10.1007/s40273-019-00857-7
更新日期:2020-01-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-018-0668-8
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:In Australia, many patients who are initiated on asthma controller inhalers receive combination inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) despite having asthma of sufficiently low severity that ICS-alone would be equally effective and less costly for the government. METHODS:We conducted a ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
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更新日期:2019-02-01 00:00:00
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journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200624003-00007
更新日期:2006-01-01 00:00:00