Gershon Noga, Berchenko Yakir, Hall Peter S, Goldstein Daniel A
1Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501 Israel.
2Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK.
Cost Eff Resour Alloc. 2019 Feb 28;17:5. doi: 10.1186/s12962-019-0174-7. eCollection 2019.
Breast cancer is the second most common cancer worldwide, the most common among women, and the most frequent cause of death among women in less developed regions. Trastuzumab is a humanized monoclonal antibody that downregulates the extracellular domain of the protein. Using trastuzumab to treat women with localized -positive breast cancer has been shown to improve survival. The objective of this study is to explore the cost-effectiveness of adjuvant trastuzumab, from a societal perspective, in 11 African countries. In addition, we aimed to establish value-based prices for trastuzumab based on the gross domestic product per capita in each country.
We developed a Markov model in order to assess the costs and benefits associated with trastuzumab treatment over a lifetime horizon. A probabilistic sensitivity analysis was performed in order to estimate the impact of uncertainty of parameter-values on the results. Efficacy inputs were derived using clinical trial data from non-African countries.
In the base case analysis, trastuzumab yielded a gain ranging from 0.92 LYs in Nigeria to 1.07 LYs in South Africa, and 0.9 QALYs in Nigeria to 1.02 QALYs in South Africa. The incremental cost ranged from 19,561 USD in Nigeria to 19,997 USD in Congo, and an incremental cost-effectiveness ratio ranging from 19,534 USD/QALY in South Africa to 21,697 USD/QALY in Nigeria. Using willingness to pay estimates based on World Health Organization recommendations, trastuzumab appear to not be cost-effective in all countries analyzed. Cost-effectiveness estimates were most sensitive to the discount rate, trastuzumab cost, and the hazard ratio.
Trastuzumab does not appear to be cost effective in the African countries analyzed. In order for trastuzumab to be cost-effective, the costs of treatment would require significant discounts.
乳腺癌是全球第二大常见癌症，是女性中最常见的癌症，也是欠发达地区女性最常见的死因。曲妥珠单抗是一种人源化单克隆抗体，可下调该蛋白的细胞外结构域。已证明使用曲妥珠单抗治疗局部HER2阳性乳腺癌女性可提高生存率。本研究的目的是从社会角度探讨在11个非洲国家辅助使用曲妥珠单抗的成本效益。此外，我们旨在根据每个国家的人均国内生产总值确定曲妥珠单抗基于价值的价格。
我们开发了一个马尔可夫模型，以评估曲妥珠单抗治疗一生期间的成本和效益。进行了概率敏感性分析，以估计参数值不确定性对结果的影响。疗效数据来自非非洲国家的临床试验。
在基础病例分析中，曲妥珠单抗带来的收益从尼日利亚的0.92个生命年到南非的1.07个生命年，以及从尼日利亚的0.9个质量调整生命年到南非的1.02个质量调整生命年。增量成本从尼日利亚的19,561美元到刚果的19,997美元，增量成本效益比从南非的19,534美元/质量调整生命年到尼日利亚的21,697美元/质量调整生命年。根据世界卫生组织的建议使用支付意愿估计，曲妥珠单抗在所有分析的国家似乎都不具有成本效益。成本效益估计对贴现率、曲妥珠单抗成本和风险比最为敏感。
在分析的非洲国家，曲妥珠单抗似乎不具有成本效益。为了使曲妥珠单抗具有成本效益，治疗成本需要大幅折扣。
