Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pharmacy, Institut Teknologi Sumatera, Lampung Selatan, Indonesia.
PLoS One. 2024 May 24;19(5):e0304483. doi: 10.1371/journal.pone.0304483. eCollection 2024.
Trastuzumab has significantly enhanced the survival and prognosis of individuals diagnosed with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. Considering its relatively high costs, we aimed to examine the cost-effectiveness of trastuzumab plus chemotherapy compared with chemotherapy alone in HER2-positive early breast cancer from an Indonesian healthcare payer's perspective.
A Markov model was developed to project the lifetime health benefits and costs associated with trastuzumab treatment for a cohort of women with HER2-positive early breast cancer. Efficacy data and baseline characteristics in the base-case analysis were primarily derived from the 11-year results of the HERA trial. Costs were based on verified reimbursement data from Indonesia's Health and Social Security Agency (BPJS Kesehatan) of the year 2020. A scenario analysis was conducted with efficacy data based on the joint analysis from the NSABP B-31 and NCCTG N9831 trials, allowing for subgroup analysis by age at diagnosis. Univariate and probabilistic sensitivity analyses were conducted to assess the influence of parameter uncertainty.
In the base-case analysis, the results indicated that the lifetime costs for trastuzumab plus chemotherapy and chemotherapy alone were US$33,744 and US$22,720, respectively, resulting in substantial incremental savings of US$11,024 per patient for the former. Trastuzumab plus chemotherapy also led to higher total quality-adjusted life years (QALYs) and life years gained (LYG), resulting in incremental cost-effectiveness ratios (ICERs) of US$6,842 per QALY and US$5,510 per LYG. In scenario analysis, the subgroup with an age at diagnosis <40 years old reflected the most cost-effective subgroup. Both the base-case and scenario analyses demonstrated cost-effectiveness with a willingness-to-pay threshold of three-times Gross Domestic Product (GDP). Sensitivity analyses confirmed the robustness of the findings and conclusions.
In Indonesia, trastuzumab plus chemotherapy can be considered cost-effective compared to chemotherapy alone at a willingness-to-pay threshold of three times GDP, and it is likely most cost-effective in women <40 years of age.
曲妥珠单抗显著提高了人表皮生长因子受体 2（HER2）阳性早期乳腺癌患者的生存率和预后。鉴于其相对较高的成本，我们旨在从印度尼西亚医疗保健支付者的角度评估曲妥珠单抗联合化疗与单独化疗在 HER2 阳性早期乳腺癌中的成本效益。
我们开发了一个马尔可夫模型，以预测曲妥珠单抗治疗 HER2 阳性早期乳腺癌患者的终生健康效益和成本。基础分析中的疗效数据和基线特征主要来源于 HERA 试验 11 年的结果。成本基于印度尼西亚健康和社会保障机构（BPJS Kesehatan）2020 年的核实报销数据。我们进行了一项情景分析，其疗效数据基于 NSABP B-31 和 NCCTG N9831 试验的联合分析，允许按诊断时的年龄进行亚组分析。我们进行了单变量和概率敏感性分析，以评估参数不确定性的影响。
在基础分析中，曲妥珠单抗联合化疗和单独化疗的终生成本分别为 33744 美元和 22720 美元，前者为每位患者节省了 11024 美元的增量成本。曲妥珠单抗联合化疗还带来了更高的总质量调整生命年（QALYs）和生命年获得（LYG），增量成本效益比（ICER）分别为每 QALY 6842 美元和每 LYG 5510 美元。在情景分析中，诊断年龄<40 岁的亚组反映了最具成本效益的亚组。基础分析和情景分析均表明，在支付意愿阈值为三倍国内生产总值（GDP）的情况下，曲妥珠单抗联合化疗具有成本效益。敏感性分析证实了研究结果和结论的稳健性。
在印度尼西亚，与单独化疗相比，曲妥珠单抗联合化疗在支付意愿阈值为三倍 GDP 的情况下具有成本效益，并且在<40 岁的女性中可能最具成本效益。
