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Annals of Oncology 2007 18(9):1493-1499; doi:10.1093/annonc/mdm185
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© 2007 European Society for Medical Oncology

breast cancer

Cost-effectiveness of trastuzumab in the adjuvant treatment of early breast cancer: a model-based analysis of the HERA and FinHer trial

KJ Dedes1,*, TD Szucs2, P Imesch1, A Fedier1, MK Fehr1 and D Fink1

1 Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich
2 Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

* Correspondence to: Dr K. J. Dedes, Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland. Tel: +41-44-255-52-00; Fax: +41-44-255-44-33; E-mail: konstantin.dedes{at}usz.ch

Background: Routine adjuvant administration of trastuzumab (T) has been implemented in most centers, but its economic impact has not yet been well examined.

Methods: A Markov model was constructed based on clinical data of the Herceptin Adjuvant (HERA) and the Finland Herceptin (FinHer) trials. Costs from the perspective of a Swiss health care provider were calculated based on resource use.

Results: On the basis of HERA data, our model yielded an overall survival rate of 71.8% for the T group versus 62.8% for the control group [risk ratio (RR) = 0.87) after 10 years and 62.9% versus 52.7% (RR = 0.84) after 15 years. Cost-effectiveness resulted in 40505 Euros (EUR) per life years gained (LYG) after 10 years and 19673 EUR per LYG after 15 years. For the FinHer regimen, overall survival after 10 and 15 years resulted in 81.8% versus 66.1% (RR = 0.81) and 73.6% versus 57.0% (RR = 0.77). Costs of 8497 EUR per patient could be saved after 10 years and 9256 EUR after 15 years compared with the control group.

Conclusion: In a long-term perspective, adjuvant T based on the HERA regimen can be considered cost-effective. The regimen used in the FinHer trial is even cost saving, but estimations are based on a single small trial.

Key words: adjuvant treatment, breast cancer, cost-effectiveness, trastuzumab

Received for publication October 30, 2006. Revision received January 23, 2007. Revision received March 21, 2007. Accepted for publication April 11, 2007.


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