School of Public Health, Fudan University, Shanghai, China.
Value Health. 2009 Nov-Dec;12 Suppl 3:S82-4. doi: 10.1111/j.1524-4733.2009.00634.x.
One-year adjuvant trastuzumab therapy increases disease-free and overall survival in the adjuvant treatment of early HER2-positive breast cancer. This study aims to assess the long-term cost-effectiveness of adjuvant trastuzumab treatment in Beijing, Shanghai, and Guangzhou.
A Markov health-state transition model was constructed to simulate the natural development of breast cancer based on HERceptin Adjuvant (HERA) trial, estimate costs and disease progression over a lifetime perspective with annual transition cycles, and evaluate the cost-effectiveness of 1-year adjuvant trastuzumab treatment group compared with the standard adjuvant chemotherapy. From the perspective of a China health insurance system, cost was calculated based on a survey from clinical expert panels.
On the basis of HERA data, the model results showed that the utilization of adjuvant trastuzumab treatment in early breast cancer can prolong 2.87 life years, compared with the standard chemotherapy group. The incremental cost for an additional life-year gained (LYG) was US$7564, US$7933, and US$7929 in Beijing, Shanghai, and Guangzhou, respectively. If measured by quality-adjusted life-year, the incremental cost-effectiveness ratio was US$7676, US$8049, and US$8046, respectively.
The results suggest that the 1-year adjuvant trastuzumab treatment is cost-effective. Both clinical and economic benefits were superior for the 1-year adjuvant trastuzumab treatment group compared with the standard adjuvant chemotherapy group.
曲妥珠单抗辅助治疗可增加早期 HER2 阳性乳腺癌的无病生存和总生存。本研究旨在评估曲妥珠单抗辅助治疗在北京、上海和广州的长期成本效益。
基于 HERceptin Adjuvant（HERA）试验，构建了马尔可夫健康状态转移模型来模拟乳腺癌的自然发展，从终生角度估计年度转换周期的成本和疾病进展情况，并评估 1 年曲妥珠单抗辅助治疗组与标准辅助化疗的成本效益。从中国医疗保险制度的角度出发，根据临床专家小组的调查来计算成本。
基于 HERA 数据，模型结果表明，早期乳腺癌中曲妥珠单抗辅助治疗的应用可延长 2.87 个生命年，与标准化疗组相比。在北京、上海和广州，每获得额外 1 个生命年的增量成本分别为 7564 美元、7933 美元和 7929 美元。如果以质量调整生命年来衡量，增量成本效益比分别为 7676 美元、8049 美元和 8046 美元。
结果表明，1 年曲妥珠单抗辅助治疗具有成本效益。与标准辅助化疗组相比，1 年曲妥珠单抗辅助治疗组在临床和经济效益方面均具有优势。
