Cost-effectiveness of six months versus 1-year adjuvant trastuzumab in HER2 positive early breast cancer in Egypt

Figures & data

Figure 1. Markov model diagram.

Table 1. Model input variables.

	Base case	Low value	High value	References
Parameters
Annual rate of death from metastases disease	0.328	0.2952	0.3608	^8
Increased risk of distant metastasis after local recurrence_Year 1–4	3.22	2.898	3.542	^21
Increased risk of distant metastasis after local recurrence_Year 5–10	6.14	5.526	6.754	^21
Transition of local recurrence to disease free survival (4 years)	0.1	0.09	0.11	^22
Transition of local recurrence to metastasis (4 years)	0.0785	0.07065	0.08635	^22
Transition of disease free survival to local recurrence (4 years)	0.0294	0.02646	0.03234	^22
Transition of disease free survival to metastasis (4 years)	0.0785	0.07065	0.08635	^23
4 year disease free survival _12 months	0.898	0.8082	0.9878	^24
4 year disease free survival _6 months	0.894	0.8046	0.9834	^24
local recurrence in 12 months	0.0386	0.03474	0.04246	^24
local recurrence in 6 months	0.0376	0.03384	0.04136	^24
Probability of distant metastasis_12 months	.0894	.08046	.09834	^24
Probability of distant metastasis_6 months	.0930	.0837	.1023	^24
Probability of death_12 months	.0762	.06858	.08382	^24
Probability of death_6 months	.0876	.07884	.09636	^24
Probability of cardiotoxicity_ 6 months	.031	.02826	.03454	^24
Probability of cardiotoxicity_ 12 months	.077	.0693	.0847	^24
Costs
Echo cardiography unit cost	250	225	275	Army hospital
Trastuzumab cost/cycle	14,630	13,167	16,093	Army hospital
Number of daycare days in 6 months	9	8.1	9.9	Army hospital
Number of daycare days in 12 months	17	15.3	18.7	Army hospital
Cost of one day care	150	135	165	Army hospital
Discount rate	0.035	0.0315	0.0385	^20
Metastatic relapse cost before 1 year (macrocost)	119,730	95,784	143,676	Army hospital
Metastatic relapse cost beyond 1 year (macrocost)	741,170	592,936	889,404	Army hospital
Total follow up cost for disease free survival (macrocost)	1,180	944	1,416	Army hospital
Follow up cost in metastasis (macrocost)	1,800	1,440	2,160	Army hospital
Disease free survival total cost (macrocost)	1,180	944	1,416	Army hospital
Local recurrence cost (macrocost)	14,000	11,200	16,800	Army hospital
Utilities
Disease free survival utility	0.696	0.6232	0.9348	^25
Loco- regional relapse utility	0.78	0.624	0.936	^25
Metastatic relapse utility	0.69	0.552	0.828	^26
Patient_HER 2 + ve utility	0.779	0.6232	0.9348	^25
Symptomatic cardiotoxicity utility	0.6	0.48	0.72	^27

Table 2. Decision analytic model results.

Model results
Treatment strategy	Total costs (EGP)	Incremental cost (EGP)	Total QALYs	Incremental QALYs	ICER	Interpretation
6-month trastuzumab	271,647	–109,600	2.9987	0.45517	0.061 EGP/QALY	Baseline comparator
1-year trastuzumab	381,248		2.9376			Dominant

Figure 2. Results of one-way sensitivity analyses of 6-month compared to 1-year trastuzumab reported in the Egyptian currency. The white grey bar corresponds with the upper range, and the dark bar with the lower range of an input.

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