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. Incremental quality-adjusted life-years for trastuzumab versus chemotherapy alone are two times higher (2.33 times for the age group 50-54 y; 95% CI 2.29-2.37) for the worst prognosis (ER-/PR-) subtype compared to the best prognosis (ER+/PR+) subtype, causing incremental cost-effectiveness ratios (ICERs) for the former to be less than half those of the latter for the age groups from 25-29 to 90-94 y (0.44 times for the age group 50-54 y; 95% CI 0.43-0.45). If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]-adjusted: US$30,300; €23,700; £21,200), our study suggests that trastuzumab (2011 PPP-adjusted US$45,400/€35,900/£21,900 for 1 y at formulary prices) may not be cost-effective for ER+ (which are 61% of all) node-positive HER2+ early breast cancer patients but cost-effective for ER-/PR- subtypes (37% of all cases) to age 69 y. Market entry of trastuzumab biosimilars will likely reduce the ICER to below this threshold for premenopausal ER+/PR- cancer but not for ER+/PR+ cancer. Sensitivity analysis using the best-case effectiveness measure for ER+ cancer had the same result. A key limitation was a lack of treatment-effect data by hormone receptor subtype. Heterogeneity was restricted to age and hormone receptor status; tumour size/grade heterogeneity could be explored in future work. 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.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Leung W,Kvizhinadze G,Nair N,Blakely Tdoi
10.1371/journal.pmed.1002067subject
Has Abstractpub_date
2016-08-09 00:00:00pages
e1002067issue
8eissn
1549-1277issn
1549-1676pii
PMEDICINE-D-15-02857journal_volume
13pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:In patients treated with cardiotoxic chemotherapies, the presence of cardiovascular risk factors and previous cardiac disease have been strongly correlated to the onset of cardiotoxicity. The influence of overweight and obesity as risk factors in the development of treatment-related cardiotoxicity in breast ...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1002989
更新日期:2019-12-23 00:00:00
abstract:BACKGROUND:Polygenic risk scores (PRSs) can stratify populations into cardiovascular disease (CVD) risk groups. We aimed to quantify the potential advantage of adding information on PRSs to conventional risk factors in the primary prevention of CVD. METHODS AND FINDINGS:Using data from UK Biobank on 306,654 individual...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003498
更新日期:2021-01-14 00:00:00
abstract::David Studdert and colleagues explore how to balance public health, individual freedom, and good government when it comes to sugar-sweetened drinks. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001848
更新日期:2015-07-07 00:00:00
abstract:BACKGROUND:Evidence suggests that variations in fasting glucose and insulin amongst those without frank type 2 diabetes mellitus are important determinants of cardiovascular disease. However, the relative importance of variations in fasting insulin, glucose, and glycated haemoglobin as risk factors for cardiovascular d...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040263
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness o...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001876
更新日期:2015-09-15 00:00:00
abstract:BACKGROUND:Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretrovi...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1001015
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:A nonsputum blood test capable of predicting progression of healthy individuals to active tuberculosis (TB) before clinical symptoms manifest would allow targeted treatment to curb transmission. We aimed to develop a proteomic biomarker of risk of TB progression for ultimate translation into a point-of-care ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002781
更新日期:2019-04-16 00:00:00
abstract:BACKGROUND:Various risk factors have been associated with epithelial ovarian cancer risk in observational epidemiological studies. However, the causal nature of the risk factors reported, and thus their suitability as effective intervention targets, is unclear given the susceptibility of conventional observational desi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002893
更新日期:2019-08-07 00:00:00
abstract:BACKGROUND:There have been increasing concerns regarding the safety and efficacy of neuroleptics in people with dementia, but there are very few long-term trials to inform clinical practice. The aim of this study was to determine the impact of long-term treatment with neuroleptic agents upon global cognitive decline an...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1371/journal.pmed.0050076
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Helminth and protozoan infections affect more than 1 billion children globally. Improving water quality, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration, while providing other quality of life benefits. METHODS AND FIND...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1002841
更新日期:2019-06-26 00:00:00
abstract:BACKGROUND:Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence a...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001295
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The World Health Organization has endorsed the Xpert MTB/RIF assay for investigation of patients suspected of having tuberculosis (TB). However, its utility for routine TB screening and detection of rifampicin resistance among HIV-infected patients with advanced immunodeficiency enrolling in antiretroviral t...
journal_title:PLoS medicine
pub_type: 临床试验,杂志文章
doi:10.1371/journal.pmed.1001067
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Psoriasis is a common inflammatory skin disease that has been reported to be associated with obesity. We aimed to investigate a possible causal relationship between body mass index (BMI) and psoriasis. METHODS AND FINDINGS:Following a review of published epidemiological evidence of the association between o...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1002739
更新日期:2019-01-31 00:00:00
abstract::Nathan Ford and Gottfried Hirnschall reflect on recent research by Jan Hontelez and colleagues published in this week's PLOS Medicine. The authors argue that the future HIV modeling efforts should focus on helping programs make choices about which interventions need to be prioritized in order to achieve the levels of ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1001535
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Experimental studies have suggested that dipeptidyl peptidase-4 (DPP-4) inhibitors provide cardiovascular protective effects. We performed a randomized study to evaluate the effects of sitagliptin added on to the conventional therapy compared with conventional therapy alone (diet, exercise, and/or drugs, exc...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1371/journal.pmed.1002051
更新日期:2016-06-28 00:00:00
abstract:BACKGROUND:Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimat...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001080
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:Schistosomiasis--infection with helminth parasites in the genus Schistosoma, including S. mansoni--is a widespread, devastating tropical disease affecting more than 200 million people. No vaccine is available, and praziquantel, the only drug extensively utilized, is currently administered more than 100 milli...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040206
更新日期:2007-06-01 00:00:00
abstract::Kwonjune Seung and colleagues describe the Eugene Bell Foundation's experience of treating MDR-TB in North Korea. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002062
更新日期:2016-08-02 00:00:00
abstract:BACKGROUND:There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001409
更新日期:2013-01-01 00:00:00
abstract::In this month's editorial, PLOS Medicine's Chief Editor Larry Peiperl discusses the relevance of patient care to a journal editor's work. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002394
更新日期:2017-09-26 00:00:00
abstract:BACKGROUND:Pediatric acute lymphoblastic leukemia (ALL) is the most common childhood cancer and the leading cause of cancer-related mortality in children. T cell ALL (T-ALL) represents about 15% of pediatric ALL cases and is considered a high-risk disease. T-ALL is often associated with resistance to treatment, includi...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002200
更新日期:2016-12-20 00:00:00
abstract::In an essay, Paul Bloem and Ikechukwu Ogbuanu discuss the public health implications of HPV vaccination. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002325
更新日期:2017-06-27 00:00:00
abstract:BACKGROUND:Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Ag...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002220
更新日期:2017-01-24 00:00:00
abstract:BACKGROUND:Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on long-term mortality trends in the US ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050066
更新日期:2008-04-22 00:00:00
abstract:BACKGROUND:Previous epidemiological studies suggest that working-aged persons with a history of moderate-to-severe traumatic brain injury (TBI) may have an increased risk for developing neurodegenerative disease (NDD) while persons with a history of mild TBI do not. In this comprehensive nationwide study in Finland, we...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002316
更新日期:2017-07-05 00:00:00
abstract::Philippe Calain discusses the health and environmental hazards of extractive industries like mining and explores the tensions that arise when medical humanitarian organizations are called to intervene in emergencies involving the extractive sector. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001302
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. METHODS AND FINDINGS:A total of 3,274 uncircumcised men, aged 18-24 y, were randomiz...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.0020298
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Oncolytic viruses hold much promise for clinical treatment of many cancers, but a lack of systemic delivery and insufficient tumor cell killing have limited their usefulness. We have previously demonstrated that vaccinia virus strains are capable of systemic delivery to tumors in mouse models, but infection ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040353
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. METHODS AND FINDINGS:We perf...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001670
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:A number of epidemiologic studies have observed an association between secondhand smoke (SHS) exposure and pediatric invasive bacterial disease (IBD) but the evidence has not been systematically reviewed. We carried out a systematic review and meta-analysis of SHS exposure and two outcomes, IBD and pharyngea...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1371/journal.pmed.1000374
更新日期:2010-12-07 00:00:00