Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia.
Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Asian Pac J Cancer Prev. 2022 Jul 1;23(7):2441-2447. doi: 10.31557/APJCP.2022.23.7.2441.
Breast cancer is the most common cancer in Indonesia, with Indonesia's breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia.
We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost-utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs).
From a healthcare provider's perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million.
In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not cost-effective in terms of PFS and OS compared with chemotherapy alone.
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乳腺癌是印度尼西亚最常见的癌症，其乳腺癌死亡率在东南亚国家中最高。本研究旨在评估在印度尼西亚，与单独化疗相比，曲妥珠单抗联合化疗用于治疗 HER2 阳性乳腺癌患者的成本效益和预算影响。
方法：我们进行了一项基于马尔可夫模型的经济评估，以评估成本效益、成本效用和预算影响。效用数据、直接医疗成本和间接成本主要通过访谈患者获得。另一方面，临床疗效数据来自系统评价和真实世界数据，并通过无进展生存期、总生存期和质量调整生命年（QALYs）来表示。
结果：从医疗保健提供者的角度来看，联合组的总费用为 14516 美元，而单独化疗组的费用为 7489 美元。虽然成本效益分析表明联合组的总成本高出 7027 美元，但化疗组的无进展生存期更长，相差 2.2 个月。每获得一个质量调整生命年的增量成本效益比（ICER）为 17307 美元。在 5 年内添加曲妥珠单抗的总成本为 5.89 亿美元。
结论：总之，这项经济评估表明，与单独化疗相比，曲妥珠单抗联合标准化疗在无进展生存期和总生存期方面并不具有成本效益。
