Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Unidad Docente de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
PLoS One. 2020 Feb 5;15(2):e0227961. doi: 10.1371/journal.pone.0227961. eCollection 2020.
Trastuzumab (TZM) improves survival and the risk of recurrence among patients with early-stage HER2+ breast cancer (BC). TZM treatment can be given intravenously (IV-TZM) or subcutaneously (SC-TZM). Although both methods have similar efficacy and safety, they differ in dosage and administration. Previous studies of cost minimization determined that SC-TZM is associated with lower costs than IV-TZM; however, those studies did not include the costs associated with body weight-based dosage and the treatment of adverse drug reactions (ADRs).
METHODS/PATIENTS: We performed a model-based cost-minimization analysis. The analysis included direct and indirect medical costs associated with TZM preparation (adjusted by body weight) and administration and also costs due to severe ADRs and non-medical costs that occurred during the total treatment course (18 cycles). We performed a sensitivity analysis to test the robustness of the results across various TZM costs and patient body weights.
The overall cost (in USD) of IV-TZM treatment was $83,309.1 per patient compared with $77,067.7 per patient for SC-TZM. Thus, one year of SC-TZM treatment cost $6,241.4 less per patient than one year of IV-TZM treatment. The sensitivity analysis revealed that the results were mainly driven by the price of each TZM vial and body weight.
SC-TZM is a cost-saving therapy for Chilean patients with early-stage HER2+ BC. Given their similar efficacy and safety, we suggest the use of SC formulations rather than IV formulations. The use of SC-TZM instead of IV-TZM may have a significant economic impact on public/private healthcare systems.
曲妥珠单抗（TZM）可提高早期 HER2+ 乳腺癌（BC）患者的生存率和复发风险。TZM 可通过静脉内（IV-TZM）或皮下（SC-TZM）给药。虽然这两种方法的疗效和安全性相似，但在剂量和给药方式上有所不同。先前关于成本最小化的研究表明，SC-TZM 的成本低于 IV-TZM；然而，这些研究并未包括与基于体重的剂量和药物不良反应（ADR）治疗相关的成本。
方法/患者：我们进行了基于模型的成本最小化分析。该分析包括与 TZM 准备（根据体重调整）和给药相关的直接和间接医疗成本，以及因严重 ADR 和总治疗过程中发生的非医疗成本（18 个周期）而产生的成本。我们进行了敏感性分析，以测试在各种 TZM 成本和患者体重下结果的稳健性。
IV-TZM 治疗的总费用（以美元计）为每位患者 83,309.1 美元，而 SC-TZM 为每位患者 77,067.7 美元。因此，SC-TZM 治疗每年可为每位患者节省 6,241.4 美元。敏感性分析表明，结果主要受每个 TZM 小瓶的价格和体重驱动。
SC-TZM 是智利早期 HER2+BC 患者的一种节省成本的治疗方法。鉴于它们具有相似的疗效和安全性，我们建议使用 SC 制剂而不是 IV 制剂。使用 SC-TZM 代替 IV-TZM 可能对公共/私人医疗保健系统产生重大的经济影响。
