Aboutorabi Ali, Hadian Mohammad, Ghaderi Hossein, Salehi Masoud, Ghiasipour Maryam
Department. of Health Economics, School of Health management and information science, Iran University of Medical Sciences, Tehran, Iran.
Glob J Health Sci. 2014 Aug 14;7(1):98-106. doi: 10.5539/gjhs.v7n1p98.
Evidence from randomized controlled trials (RCTs) has shown a significant survival advantage of trastuzumab. Although extant work in developed countries examined economic evaluation of trastuzumab in adjuvant treatment for early breast cancer based on the 1-year treatment, there is uncertainty about cost-effectiveness of trastuzumab in the Adjuvant Treatment of early breast cancer in developing countries. This study aimed to estimate cost-effectiveness of adjuvant trastuzumab therapy compared to AC-T regimen in early breast cancer in Iran.
A cost-effectiveness analysis was performed using a Markov model to estimate outcomes and costs over a 20-year time period using a cohort of women with HER2 positive early breast cancer, treated with or without 12 months trastuzumab adjuvant chemotherapy. Transition probabilities were derived mainly from the BCIRG006 trial. Costs were estimated from the perspective of the Iranian health care system. Both costs and outcomes were discounted by 3%. One-way sensitivity analysis was undertaken to assess the associated uncertainties in the expected output measures.
On the basis of BCIRG006 trial, our model showed that adjuvant trastuzumab treatment in early breast cancer, yield 0.87 quality-adjusted life-years (QALY) compared with AC-T regimen. Adjuvant trastuzumab treatment yielded an incremental cost-effectiveness ratio (ICER) of US$ 51302 per QALY.
By using threshold of 3 times GDP per capita, as per World Health Organization (WHO) recommendation, 12 months trastuzumab adjuvant chemotherapy is not a cost-effective therapy for patients with HER2-positive breast cancer in Iran.
随机对照试验（RCT）的证据表明曲妥珠单抗具有显著的生存优势。尽管发达国家现有研究基于1年治疗对曲妥珠单抗在早期乳腺癌辅助治疗中的经济评估进行了考察，但在发展中国家，曲妥珠单抗在早期乳腺癌辅助治疗中的成本效益仍存在不确定性。本研究旨在评估在伊朗早期乳腺癌中，辅助性曲妥珠单抗治疗与AC-T方案相比的成本效益。
采用马尔可夫模型进行成本效益分析，以估计一组HER2阳性早期乳腺癌女性患者在20年时间内接受或不接受12个月曲妥珠单抗辅助化疗的结局和成本。转移概率主要来源于BCIRG006试验。成本从伊朗医疗保健系统的角度进行估计。成本和结局均按3%进行贴现。进行单向敏感性分析以评估预期产出指标中的相关不确定性。
基于BCIRG006试验，我们的模型显示，早期乳腺癌辅助性曲妥珠单抗治疗与AC-T方案相比，可产生0.87个质量调整生命年（QALY）。辅助性曲妥珠单抗治疗的增量成本效益比（ICER）为每QALY 51302美元。
根据世界卫生组织（WHO）的建议，采用人均GDP的3倍作为阈值，12个月曲妥珠单抗辅助化疗对伊朗HER2阳性乳腺癌患者而言并非具有成本效益的治疗方法。
