Cost-effectiveness analysis of trastuzumab for early breast cancer in Brazil

ABSTRACT

Background

Adjuvant chemotherapy with trastuzumab for HER2 positive breast cancers has brought considerable benefits to disease-free survival and overall survival.

Objective

To conduct a cost-effectiveness analysis of the treatment of patients with early and locally advanced HER2 positive breast cancer, within the scope of the Brazilian public health system, comparing adjuvant chemotherapy with and without trastuzumab, for 1 year of treatment.

Methods

A 4-state Markov model was developed to estimate strategy costs and outcomes.

Results

Based on the proposed model, we verified an incremental benefit of trastuzumab therapy compared to treatment without trastuzumab with 0.84 quality-adjusted life years (QALY) and 1.16 life years gained (LYG). The use of adjuvant chemotherapy with trastuzumab has an ICER of US$19,599.26 for each quality-adjusted life year and US$14,180.68 for each life year gained in relation to chemotherapy without trastuzumab.

Conclusion

In Brazil, adjuvant chemotherapy with trastuzumab may be considered cost-effective only if a cost-effectiveness threshold is stipulated with the value starting at three times the Brazilian GDP per capita for QALY or two times the Brazilian GDP per capita for LYG, from health system perspective.

KEYWORDS:

• Key-words: Health Economics
• economic Evaluation
• cost-effectiveness
• cost-utility
• health System
• HER2 Positive Breast Cancer

Acknowledgments

The authors would like to thank Alexandre Ferreira Ramos, Eduardo Vicentin, Evelinda Marramon Trindade, Everton Nunes da Silva, Fábio Tosetto Reale, Ivo Bucaresky, José Ruben Ferreira de Alcântara Bonfim, Monica Vinhas de Souza and Rossana Verónica Mendoza López for their contributions to this study.

Declarations

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethics approval

Cancer Institute of Sao Paulo - Faculty of Medicine, University of Sao Paulo Registration: NP850/2016 - 9 January 2017.

Availability of data and material

I provide the data through contact by email.

Code availability

We describe in the article the software (R, Rstudio and the R packages) that were used in the simulation and that can be accessed for free.

Supplementary material

Supplemental data for this article can be accessed here.

Notes

^1. PPP = Purchasing Power Parity.

Additional information

Funding

CHB was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES) through a Research Grant during the master’s degree at the University of Sao Paulo.CAPES - FINANCIAL ASSISTANCE TO STUDENTS Case No.: 2017SLR17986