| Abstract | OBJECTIVE: To identify published, original, cost-effectiveness analyses presenting cost/quality-adjusted life year (QALY) ratios for trastuzumab used as an adjuvant treatment for HER2-positive early breast cancer and to evaluate the quality of reporting the favorable cost-effectiveness ratios. DATA SOURCES: The terms trastuzumab adjuvant therapy, cost-effectiveness, quality-adjusted, QALY, and early breast cancer were searched in MEDLINE, PubMed, Embase, and CancerLit, as well as in Cochrane economic evaluation and reference lists from 1998 to June 2008. Only English-language publications were eligible. STUDY SELECTION AND DATA EXTRACTION: All published studies examining cost-effectiveness outcomes on the basis of modeling or clinical trials were included. Cost-effectiveness analysis that measured health effects in units other than QALY, life year gained, neoadjuvant data, reviews, and comments were excluded. Each study was assessed independently by 2 trained reviewers. DATA SYNTHESIS: Thirteen of the 239 articles identified met the inclusion criteria, with 23 cost-effectiveness ratios pertaining to treatment of early breast cancer. These ratios ranged from $5020/QALY to $134,610/QALY. Most studies reported favorable cost-effectiveness values (ie, below $50,000/QALY). About 84.6% were conducted using a Markov model based on data from clinical trials and 15.3% were analyzed by other economic or cost models; 84.6% reported sensitivity analysis, 11 studies (84.6%) clearly described a justification of selecting study design, and only 15.3% noted study limitations. All studies mentioned their perspective; 92.3% did not show the funding source. Methods of reporting costs, effectiveness, and time-horizons for disease states varied significantly. Nine (69.2%) studies used a discount rate of 3%, 3 studies used a discount rate of 5%, and 1 study used 3.5%. The mean quality of the studies was 4.43. CONCLUSIONS: Most studies presenting the frequently proposed threshold of QALY suggest that trastuzumab may be cost-effective for treatment of early breast cancer in a 1-year treatment regimen. |
| Authors | Agnes L F Chan, Henry W C Leung, Chin-Li Lu, Shun Jin Lin
(Affiliation: School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.)
|
| Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 43
Issue 2
Pg. 296-303
(Feb 2009)
ISSN: 1542-6270 [Electronic] United States |
| PMID | 19193576
(Publication Type: Evaluation Studies, Journal Article, Review)
|
| Chemical References |
- Antibodies, Monoclonal
- trastuzumab
|
| Topics |
- Antibodies, Monoclonal
(administration & dosage, economics, therapeutic use)
- Breast Neoplasms
(drug therapy, therapy)
- Chemotherapy, Adjuvant
(economics)
- Clinical Trials as Topic
- Cost-Benefit Analysis
- Female
- Humans
- Models, Economic
- Quality-Adjusted Life Years
- Research Design
- Time Factors
|
