Seferina Shanly C, Ramaekers Bram L T, de Boer Maaike, Dercksen M Wouter, van den Berkmortel Franchette, van Kampen Roel J W, van de Wouw Agnès J, Voogd Adri C, Tjan Heijnen Vivianne C G, Joore Manuela A
Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Oncotarget. 2017 Apr 9;8(45):79223-79233. doi: 10.18632/oncotarget.16985. eCollection 2017 Oct 3.
We assessed the real world costs and cost-effectiveness of the addition of trastuzumab in HER2 positive early breast cancer compared to chemotherapy alone in the Dutch daily practice as opposed to the results based on trial data and based on a subset of patients that were treated according to the guidelines.
In a cohort study, we included all patients with stage I-III invasive breast cancer treated with curative intent in 5 Dutch hospitals between 2005 and 2007 (=2684).We assessed three scenarios: a real-world scenario, a trial scenario and a guideline scenario, with costs and effectiveness based on either the cohort study, the published trials or the guidelines. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were constructed.
Costs were €243,216 and €239,657 for trastuzumab and no trastuzumab for the real world scenario, €224,443 and €218,948 for the guideline scenario and €253,666 and €265,116 for the trial scenario. The QALYs were 0.827, 0.861, 0.993 for the real world, guideline and trial scenario. The corresponding ICERs were €4,304, €6,382 and dominance, respectively. CEACs showed that the probability that trastuzumab is cost-effective is ≥99% in each scenario.
Adjuvant trastuzumab in the real world can be considered cost-effective.
我们评估了在荷兰日常医疗实践中，与单纯化疗相比，在HER2阳性早期乳腺癌中添加曲妥珠单抗的实际成本和成本效益，这与基于试验数据以及基于按照指南治疗的部分患者得出的结果不同。
在一项队列研究中，我们纳入了2005年至2007年间在荷兰5家医院接受根治性治疗的所有I - III期浸润性乳腺癌患者（共2684例）。我们评估了三种情况：实际情况、试验情况和指南情况，成本和效果分别基于队列研究、已发表的试验或指南。构建了增量成本效益比（ICER）和成本效益可接受性曲线（CEAC）。
在实际情况中，使用曲妥珠单抗和不使用曲妥珠单抗的成本分别为243,216欧元和239,657欧元；在指南情况中分别为224,443欧元和218,948欧元；在试验情况中分别为253,666欧元和265,116欧元。实际情况、指南情况和试验情况的质量调整生命年（QALY）分别为0.827、0.861和0.993。相应的ICER分别为4,304欧元、6,382欧元和优势情况。CEAC显示，在每种情况下，曲妥珠单抗具有成本效益的概率≥99%。
在现实世界中，辅助使用曲妥珠单抗可被认为具有成本效益。
