Neyt M, Albrecht J, Cocquyt V
Faculty of Economics and Business Administration, Department of Economics, Ghent University, Ghent.
Ann Oncol. 2006 Mar;17(3):381-90. doi: 10.1093/annonc/mdj101. Epub 2005 Nov 30.
Herceptin (trastuzumab) is a humanized monoclonal antibody that is being tested in the adjuvant setting. Cost implications of using trastuzumab, as administered in the Breast Cancer International Research Group 006 trial, are being calculated. This provides information on the treatment's value for money.
Standard breast cancer treatment models were set up for different subpopulations according to stage (I, II, III) and menopausal condition (<50 and >50 years). Costs were calculated from the hospital's point of view, using the micro-costing method. Life expectancy data were based on literature. Our comparator was the existing practice. In addition to a sensitivity analysis, a threshold analysis on the prices of trastuzumab and docetaxel was performed to target an acceptable incremental cost-effectiveness ratio.
Treatment costs were euro 45,034 (doxorubicin and cyclophosphamide --> docetaxel and trastuzumab) or euro 47,765 (docetaxel, carboplatin and trastuzumab). This was largely (79% and 75%, respectively) attributed to trastuzumab. According to our threshold analysis, an acceptable incremental cost-effectiveness ratio can be reached if health improvements are large enough and/or price discounts are given.
Trastuzumab is a promising but very expensive antibody. With the current pressure on health-care budgets, cost implications of using trastuzumab in adjuvant setting must be calculated before use of the product becomes wide-spread. This provides essential information for price-setting policies and for policy makers considering reimbursement.
赫赛汀（曲妥珠单抗）是一种正在辅助治疗环境中进行测试的人源化单克隆抗体。目前正在计算在乳腺癌国际研究组006试验中使用曲妥珠单抗的成本影响。这将提供有关该治疗性价比的信息。
根据分期（I、II、III期）和绝经状态（<50岁和>50岁）为不同亚组建立标准乳腺癌治疗模型。成本从医院角度计算，采用微观成本核算方法。预期寿命数据基于文献。我们的对照是现有治疗方法。除敏感性分析外，还对曲妥珠单抗和多西他赛的价格进行了阈值分析，以确定可接受的增量成本效益比。
治疗成本为45,034欧元（阿霉素和环磷酰胺→多西他赛和曲妥珠单抗）或47,765欧元（多西他赛、卡铂和曲妥珠单抗）。这在很大程度上（分别为79%和75%）归因于曲妥珠单抗。根据我们的阈值分析，如果健康改善足够大且/或给予价格折扣，可达到可接受的增量成本效益比。
曲妥珠单抗是一种有前景但非常昂贵的抗体。在当前医疗保健预算压力下，在该产品广泛使用之前，必须计算在辅助治疗中使用曲妥珠单抗的成本影响。这为定价政策和考虑报销的政策制定者提供了重要信息。
