Konishi Takaaki, Fujiogi Michimasa, Michihata Nobuaki, Ohbe Hiroyuki, Matsui Hiroki, Fushimi Kiyohide, Tanabe Masahiko, Seto Yasuyuki, Yasunaga Hideo
Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Oct 6;52(10):1115-1123. doi: 10.1093/jjco/hyac107.
In elderly patients with human epidermal growth factor 2-positive breast cancer, adjuvant chemotherapy was associated with decreased quality of life, with relatively small benefits for prognosis. We examined the cost-effectiveness of trastuzumab monotherapy versus adjuvant chemotherapy plus trastuzumab in elderly patients with human epidermal growth factor 2-positive breast cancer.
A Markov model was developed to evaluate the costs and benefits of trastuzumab monotherapy over adjuvant chemotherapy plus trastuzumab for elderly patients with human epidermal growth factor 2-positive breast cancer. We built the model with a yearly cycle over a 20-year time horizon and five health states: disease-free, relapse, post-relapse, metastasis and death. The parameters in the model were based on a previous randomized controlled trial and a nationwide administrative database in Japan. The incremental cost-effectiveness ratio, expressed as Japanese yen per the quality-adjusted life-years, was estimated from the perspective of health care payers. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte-Carlo simulations of 10 000 samples were conducted.
The incremental cost-effectiveness ratio of trastuzumab monotherapy over adjuvant chemotherapy plus trastuzumab was $\sim$1.8 million Japanese yen /quality-adjusted life-year. The one-way deterministic sensitivity analysis showed that transition probability from disease-free to metastasis status and cost of metastasis status had the greatest influence on the incremental cost-effectiveness ratio. More than half the estimates in the probabilistic sensitivity analysis were located below a threshold of willingness-to-pay of 5 million Japanese yen /quality-adjusted life-year.
In this first comparative cost-effectiveness analysis of adjuvant chemotherapy plus trastuzumab versus trastuzumab monotherapy in the elderly, the latter was found favorable for elderly patients with human epidermal growth factor 2-positive breast cancer.
在老年人类表皮生长因子2阳性乳腺癌患者中，辅助化疗与生活质量下降相关，对预后的益处相对较小。我们研究了曲妥珠单抗单药治疗与辅助化疗联合曲妥珠单抗治疗老年人类表皮生长因子2阳性乳腺癌患者的成本效益。
建立马尔可夫模型，以评估曲妥珠单抗单药治疗相对于辅助化疗联合曲妥珠单抗治疗老年人类表皮生长因子2阳性乳腺癌患者的成本和效益。我们构建的模型以20年为时间范围，每年为一个周期，包含五个健康状态：无病、复发、复发后、转移和死亡。模型中的参数基于先前的一项随机对照试验和日本的一个全国性行政数据库。从医疗保健支付者的角度估计增量成本效益比，以日元/质量调整生命年表示。进行了单向确定性敏感性分析和10000个样本的蒙特卡洛模拟概率敏感性分析。
曲妥珠单抗单药治疗相对于辅助化疗联合曲妥珠单抗治疗的增量成本效益比约为180万日元/质量调整生命年。单向确定性敏感性分析表明，从无病状态到转移状态的转变概率和转移状态的成本对增量成本效益比影响最大。概率敏感性分析中超过一半的估计值位于支付意愿阈值500万日元/质量调整生命年以下。
在这项首次对老年患者辅助化疗联合曲妥珠单抗与曲妥珠单抗单药治疗进行的比较成本效益分析中，发现后者对老年人类表皮生长因子2阳性乳腺癌患者有利。
