HTA Office, L.L.C., Cairo, Egypt.
Faculty of Pharmacy, Future University, Cairo, Egypt.
J Med Econ. 2020 Jun;23(6):575-580. doi: 10.1080/13696998.2020.1724682. Epub 2020 Feb 24.
Breast cancer is the most prevalent cancer among women in Egypt. Trastuzumab is administered with chemotherapy for patients with HER2-positive advanced breast cancer (HER2 + ve ABC) in the metastatic and adjuvant settings resulting in improved treatment outcomes, and long-term follow-up. Some studies have evaluated whether equivalent outcomes can be achieved with reduced treatment duration. This study evaluates the cost-effectiveness of 6-month versus 1-year trastuzumab treatments from payer perspective over a 10 year time horizon. A half-cycle corrected Markov model was developed with five mutually exclusive health states; patient with HER2 +ve ABC, disease-free survival (DFS), local or regional relapse, metastatic relapse, and death. A cycle length of 6 months was applied, direct medical costs including cost of treatments, day-care, surgery, health states and follow-up visits were collected, and indirect costs such as lost productivity were not estimated. The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted. Among the HER2 +ve ABC patient population in Egypt, the total QALYs of the 6-month trastuzumab were estimated to be 2.99 compared with 2.93 for the 1-year trastuzumab which resulted in a difference of 0.06 QALYs. The total costs were EGP 271,647 ($106,947) and EGP 381,248 ($150,097), respectively. These costs yielded an ICER of -109,600 EGP/QALY (-43,149 $/QALY) for the 6-month trastuzumab. The 6-month trastuzumab is a dominant strategy when compared to 1-year trastuzumab, resulting in improved effectiveness at a reduced cost. All analyses results confirmed the dominance of 6-month trastuzumab and our model robustness. This study concluded that 6-month trastuzumab is a cost-effective option when compared to 1-year trastuzumab in patients with HER2 +ve ABC in Egypt. Our findings provide health care decision makers with additional insights to best allocate available resources concurrently with the improvement of the Egyptian patient's outcomes.
在埃及，乳腺癌是女性中最常见的癌症。曲妥珠单抗与化疗联合用于 HER2 阳性晚期乳腺癌（HER2+ve ABC）患者，无论是在转移性还是辅助治疗环境中，都能改善治疗结果和长期随访结果。一些研究评估了是否可以通过缩短治疗时间来获得等效的结果。本研究从支付者的角度评估了 6 个月与 1 年曲妥珠单抗治疗 HER2+ve ABC 患者的成本效益，时间范围为 10 年。开发了一个半循环校正的马尔可夫模型，具有五个相互排斥的健康状态：HER2+ve ABC 患者、无病生存（DFS）、局部或区域复发、远处转移复发和死亡。应用 6 个月的治疗周期，收集了包括治疗、日间护理、手术、健康状态和随访访问在内的直接医疗成本，并且未估计间接成本，如生产力损失。转移概率和效用从已发表的文献中提取，并进行了确定性敏感性分析。在埃及的 HER2+ve ABC 患者人群中，6 个月曲妥珠单抗的总 QALY 估计为 2.99，而 1 年曲妥珠单抗为 2.93，差异为 0.06 QALY。总成本分别为 271647 埃镑（106947 美元）和 381248 埃镑（150097 美元）。这些成本使 6 个月曲妥珠单抗的 ICER 为-109600 埃镑/QALY（-43149 美元/QALY）。与 1 年曲妥珠单抗相比，6 个月曲妥珠单抗是一种占主导地位的策略，在降低成本的同时提高了疗效。所有分析结果均证实了 6 个月曲妥珠单抗的优势和模型的稳健性。本研究得出结论，与 1 年曲妥珠单抗相比，6 个月曲妥珠单抗在埃及的 HER2+ve ABC 患者中是一种具有成本效益的选择。我们的研究结果为医疗保健决策者提供了更多的见解，以便在改善埃及患者的治疗效果的同时，更好地分配可用资源。
