Xu Qiaoping, Yuanyuan Li, Jiejing Zhu, Jian Liu, Qingyu Li, Lingya Chen, Ying Luo, Changchen Shi, Yangling Li, Wei Yan
Department of Pharmacy, Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.
Center for Healthcare Security Dig Data and Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
Cost Eff Resour Alloc. 2021 Feb 23;19(1):11. doi: 10.1186/s12962-021-00264-w.
Breast cancer is the most common cancer among women in China. Amplification of the Human epidermal growth factor receptor type 2 (HER2) gene is present and overexpressed in 18-20% of breast cancers and historically has been associated with inferior disease-related outcomes. There has been increasing interest in de-escalation of therapy for low-risk disease. This study analyzes the cost-effectiveness of Doxorubicin/ Cyclophosphamide/ Paclitaxel/ Trastuzumab (AC-TH) and Docetaxel/Carboplatin/Trastuzumab(TCH) from payer perspective over a 5 year time horizon.
A half-cycle corrected Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients. Cost data came from studies based on a Chinese hospital. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted.
We identified 41 breast cancer patients at Hangzhou First People's Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment.No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients.Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with AC-TH, while the incremental costs were $US13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained.
This study concluded that TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities.
乳腺癌是中国女性中最常见的癌症。人表皮生长因子受体2（HER2）基因扩增存在于18%-20%的乳腺癌中且呈过表达状态，历来与较差的疾病相关预后有关。对于低风险疾病的治疗降阶梯越来越受到关注。本研究从支付方角度分析了多柔比星/环磷酰胺/紫杉醇/曲妥珠单抗（AC-TH）和多西他赛/卡铂/曲妥珠单抗（TCH）在5年时间范围内的成本效益。
构建了一个半周期校正马尔可夫模型，以模拟AC-TH组和TCH组患者发生乳腺癌事件和死亡的过程。成本数据来自基于一家中国医院的研究。进行了单向敏感性分析以及二阶蒙特卡洛分析和概率敏感性分析。转移概率和效用值从已发表的文献中提取，并进行了确定性敏感性分析。
我们在杭州市第一人民医院确定了41例乳腺癌患者，其中15例（60%）接受AC-TH治疗有部分缓解，13例（81.25%）接受TCH治疗有部分缓解。未观察到心脏毒性。28例患者中有1例出现3级或4级血液学毒性。29例患者中有6例出现相反模式的3级或4级非血液学毒性。与TCH相比，AC-TH治疗每位患者的平均质量调整生命年增益为0.25，而增量成本为13,142美元。AC-TH与TCH相比的增量成本效益比（ICER）为每获得一个质量调整生命年52,565美元。
本研究得出结论，就病理完全缓解、完全缓解和部分缓解率以及可管理的毒性而言，TCH新辅助化疗在HER2过表达乳腺癌患者中是可行且有效的。
