Lidgren M, Jönsson B, Rehnberg C, Willking N, Bergh J
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Ann Oncol. 2008 Mar;19(3):487-95. doi: 10.1093/annonc/mdm488. Epub 2007 Dec 6.
Clinical studies have demonstrated statistically significant reduction of breast cancer relapse and improved overall survival by adding trastuzumab for 1 year after adjuvant chemotherapy in human epidermal growth factor receptor-2 protein (HER2)/neu-positive breast cancer. The aim of this study was to analyze the cost-effectiveness of HER2/neu testing and the addition of 1-year adjuvant trastuzumab after adjuvant chemotherapy from a societal perspective in a Swedish setting.
We used a Markov state transition model to simulate HER2/neu testing and adjuvant trastuzumab treatment in a hypothetical cohort of early breast cancer patients.
The cost per quality adjusted life year (QALY) gained for immunohistochemical (IHC) testing for all patients with FISH confirmation of IHC 2+ and 3+ and 1-year adjuvant trastuzumab for FISH-positive patients was estimated to 36,000 euros. The strategy of FISH testing for all patients, with 1-year adjuvant trastuzumab for FISH-positive patients was associated with the longest quality adjusted survival of all evaluated treatment strategies and the cost per QALY gained was estimated to 41,500 euros. The remaining testing and treatment strategies were dominated.
FISH testing for all patients with 1-year adjuvant trastuzumab for FISH+ patients is a cost-effective treatment option from a societal perspective.
临床研究表明，在人表皮生长因子受体2蛋白（HER2）/neu阳性乳腺癌患者的辅助化疗后加用曲妥珠单抗1年，可使乳腺癌复发率在统计学上显著降低，并改善总生存期。本研究的目的是从瑞典社会的角度分析HER2/neu检测以及辅助化疗后加用1年辅助曲妥珠单抗的成本效益。
我们使用马尔可夫状态转移模型来模拟早期乳腺癌患者假想队列中的HER2/neu检测和辅助曲妥珠单抗治疗。
对于所有免疫组化（IHC）2+和3+且经荧光原位杂交（FISH）确认的患者进行IHC检测以及对FISH阳性患者进行1年辅助曲妥珠单抗治疗，每获得一个质量调整生命年（QALY）的成本估计为36,000欧元。对所有患者进行FISH检测，对FISH阳性患者进行1年辅助曲妥珠单抗治疗的策略在所有评估的治疗策略中具有最长的质量调整生存期，每获得一个QALY的成本估计为41,500欧元。其余的检测和治疗策略均处于劣势。
从社会角度来看，对所有患者进行FISH检测并对FISH阳性患者进行1年辅助曲妥珠单抗治疗是一种具有成本效益的治疗选择。
