Poncet Bénédicte, Bachelot Thomas, Colin Cyrille, Ganne Christell, Jaisson-Hot Isabelle, Orfeuvre Hubert, Peaud Pierre-Yves, Jacquin Jean-Philippe, Salles Bruno, Tigaud Jean-Dominique, Mechin-Cretinon Isabelle, Marechal François, Fournel Cécile, Trillet-Lenoir Véronique
Département d'Information Médicale, Unit of Medico-Economic Evaluation, Hospices Civils de Lyon, Lyon, France.
Am J Clin Oncol. 2008 Aug;31(4):363-8. doi: 10.1097/COC.0b013e3181637356.
This open controlled prospective study aimed at evaluating the medical and economical impact of first line chemotherapy for metastatic breast cancer (MBC).
Two groups of HER +++ MBC patients were compared: 26 were treated by a combination of trastuzumab and paclitaxel in 4 "prescriber" centers (group A) and 19 patients were treated by any chemotherapy without addition of trastuzumab, in 6 control centers (group B). The cost of chemotherapy and related hospitalizations was taken into account during the first 8 cycles.
Forty-five patients, mean age 51 years have been included. The objective response rate was significantly higher in group A (42% vs. 6%, P = 0.036). The median overall survival was 17 months longer in the group A (29 vs. 12 months). The median progression free survival rate was 12.2 months longer in the group A (19 vs. 7 months). The 1-year survival rate was 85% in the group A and 47% in the group B. The mean overall care cost was 33.271 euro per patient in group A versus 11.191 euro per patient in group B. The additional cost per saved year of life expressed as the incremental cost-effectiveness ratio is 15.370 euro 2002.
The related additional cost seems affordable for an European health care system and justifies the recommendation for its use in the subpopulation overexpressing HER2.
这项开放性对照前瞻性研究旨在评估一线化疗对转移性乳腺癌（MBC）的医学和经济影响。
比较两组HER +++ MBC患者：26例在4个“处方”中心接受曲妥珠单抗和紫杉醇联合治疗（A组），19例在6个对照中心接受不添加曲妥珠单抗的任何化疗（B组）。在前8个周期中考虑了化疗及相关住院费用。
共纳入45例患者，平均年龄51岁。A组客观缓解率显著更高（42%对6%，P = 0.036）。A组中位总生存期长17个月（29个月对12个月）。A组无进展生存期的中位数长12.2个月（19个月对7个月）。A组1年生存率为85%，B组为47%。A组患者平均总医疗费用为33271欧元，B组为11191欧元。以增量成本效益比表示的每挽救一年生命的额外成本为2002年的15370欧元。
对于欧洲医疗保健系统而言，相关的额外成本似乎是可以承受的，并且证明了在过表达HER2的亚群中使用它的建议是合理的。
