Short-course adjuvant trastuzumab therapy in early stage breast cancer in Finland: Cost-effectiveness and value of information analysis based on the 5-year follow-up results of the FinHer Trial

Figures & data

Figure 1. Scheme of the cost-effectiveness model.

Figure 2. Kaplan-Meier survival curves (continuous lines) and the fitted log-logistic model (dashed lines) for overall survival and distant disease-free survival for 9-week adjuvant trastuzumab. Vertical lines represent drop-outs. Original survival curves obtained from the FinHer trial [11].

Table I. Model parameters and their probability distributions.

Transition probability per cycle (1 month)	Probability	Distribution		Source
Disease progression
cycles 1–60 base case survival model (part 1)		Log-logistic regression		[11]
cycles 1–60 (w/trastuzumab)ˆ	0.0031ˆ			[11]
cycles 1–60 (w/o trastuzumab)ˆ	0.0048ˆ			[11]
cycles 61–120	0.0038	beta	α (0.441) β (115.56)	[11,23]
cycles 121–180	0.0030	beta	α (0.348) β (115.65)	[11,23]
cycles 181–240	0.0027	beta	α (0.313) β (115.69)	[11,23]
cycles 241->	0.0000			assumption
Progressed disease to death	0.0272	beta	α (6.39) β (228.6)	[19]
	0.0336†	beta	α (7.89) β (227.1)	[19]
Treatment cost per cycle (1 month)	Cost (€)
Early breast cancer
trastuzumab(a)*	3500	normal	SE ± 10%	[22]
trastuzumab(b)*	2800	normal	SE ± 10%	[22]
other cancer-related treatment
cycles 1–12	817	gamma	α (25) β (32.68)	[22]
cycles 13–60	57	gamma	α (25) β (2.28)	[22]
cycles 60->	5	gamma	α (2) β (0.2)	[22]
Advancer breast cancer
trastuzumab(c)	2 800	normal	SE ± 10%	[22]
other cancer-related treatment	1 122	gamma	α (25) β (44.88)	[22]
Quality of life (EQ-5D)	Utility weight
Primary breast cancer, 1st year	0.696	beta	α (177.5) β (77.1)	[21]
Primary breast cancer, subsequent years	0.779	beta	α (472.3) β (134.0)	[21]
Metastatic breast cancer	0.685	beta	α (171.1) β (78.7)	[21]
Dead	0.000

ˆUsed in a sensitivity scenario to depict treatment effect from 1 to 10 years.

†Used only in a sensitivity scenario.

*Only in trastuzumab group.

(a)During cycles 1–2 (9-week treatment).

(b)During cycles 1–12 (Only in sensitivity analysis for 12-month treatment).

(c)At maximum 12 months from disease progression.

SE: Standard error; SE ± 10% = [(Mean ± 10%)/(1.96*2)].

Figure 3. Incremental cost-effectiveness plane of adjuvant 9-week trastuzumab in early stage breast cancer in Finnish settings. QALY: Quality-adjusted life year.

Figure 4. Cost-effectiveness acceptability curves (CEACs). (A) and expected value of perfect information (EVPI) (B) of adjuvant 9-week trastuzumab in early stage breast cancer in Finnish settings. Presented with discount rates 0%, 3% and 6% for future costs and outcomes.

Figure 5. The impact of the assumptions related to length of treatment effectiveness in respect of incremental cost-effectiveness of 9-week adjuvant trastuzumab.

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