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- Title
Adjuvant Trastuzumab Therapy for Early HER2-Positive Breast Cancer in Iran: A Cost-Effectiveness and Scenario Analysis for an Optimal Treatment Strategy.
- Authors
Ansaripour, Amir; Uyl-de Groot, Carin; Redekop, W.; Uyl-de Groot, Carin A; Redekop, W Ken
- Abstract
<bold>Introduction: </bold>Clinical guidelines have recommended a 1-year trastuzumab regimen as standard care for early human epidermal growth factor receptor 2 (HER2)-positive breast cancer; however, this recommendation can have a dramatic impact on total drug expenditures in middle-income countries (MICs). We performed a cost-effectiveness analysis from the Iranian healthcare perspective to find an optimum duration of trastuzumab use in Iran.<bold>Method: </bold>We compared four treatment strategies comprising chemotherapy and varying durations of trastuzumab use (no trastuzumab, 6, 9 months, and 1 year), and a Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the strategies. We then examined the cost effectiveness of the strategies at different willingness-to-pay (WTP) thresholds and ages at onset of treatment.<bold>Results: </bold>Incremental costs (versus no trastuzumab) were €8826 (6 months), €13,808 (9 months) and €18,588 (12 months), while incremental quality-adjusted life-years (QALYs) were 0.65 (6 months), 0.87 (9 months) and 1.14 (12 months). At a threshold of 3 × gross domestic product (GDP)/capita (€21,000/QALY) and for patients younger than 59 years, the 6-month protocol was most likely to be cost effective (probability of 42%). At a threshold of 4 × GDP/capita (€28,000/QALY), the 6-month and 1-year regimens were essentially equal in cost effectiveness (37 and 35%, respectively). At this WTP threshold, the 6-month and 1-year regimens were optimal strategies only for patients up to 66 and 44 years of age, respectively.<bold>Conclusion: </bold>In contrast to clinical guidelines, 6 months of trastuzumab may be the most cost-effective option for Iran. The lower absolute WTP threshold and lower life expectancy compared with high-income countries are two crucial parameters in the cost effectiveness of interventions in MICs. It is therefore necessary to strike a balance between maximum population health and maintaining affordability in these countries.
- Subjects
IRAN; TRASTUZUMAB; HER2 gene; BREAST cancer treatment; COST effectiveness; MIDDLE-income countries; MEDICAL care; AGE distribution; BREAST tumors; CELL receptors; COMBINED modality therapy; COMPARATIVE studies; DRUG administration; LIFE expectancy; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; PROBABILITY theory; RESEARCH; TIME; EVALUATION research; QUALITY-adjusted life years
- Publication
PharmacoEconomics, 2018, Vol 36, Issue 1, p91
- ISSN
1170-7690
- Publication type
journal article
- DOI
10.1007/s40273-017-0557-6