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Annals of Oncology Advance Access originally published online on December 6, 2007
Annals of Oncology 2008 19(3):487-495; doi:10.1093/annonc/mdm488
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© The Author 2007. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

breast cancer

Cost-effectiveness of HER2 testing and 1-year adjuvant trastuzumab therapy for early breast cancer

M. Lidgren1,2,*, B. Jönsson3, C. Rehnberg1, N. Willking4 and J. Bergh4

1 Medical Management Centre, Karolinska Institutet, Stockholm
2 European Health Economics, Stockholm
3 Centre for Health Economics, Stockholm School of Economics, Stockholm
4 Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden

* Correspondence to: Dr M. Lidgren, European Health Economics, Vasagatan 38, 111 20, Stockholm, Sweden. Tel: +46-8-545-28-540; Fax: +46-8-545-28-549; E-mail: mathias.l{at}healtheconomics.se

Background: Clinical studies have demonstrated statistically significant reduction of breast cancer relapse and improved overall survival by adding trastuzumab for 1 year after adjuvant chemotherapy in human epidermal growth factor receptor-2 protein (HER2)/neu-positive breast cancer. The aim of this study was to analyze the cost-effectiveness of HER2/neu testing and the addition of 1-year adjuvant trastuzumab after adjuvant chemotherapy from a societal perspective in a Swedish setting.

Material and methods: We used a Markov state transition model to simulate HER2/neu testing and adjuvant trastuzumab treatment in a hypothetical cohort of early breast cancer patients.

Results: The cost per quality adjusted life year (QALY) gained for immunohistochemical (IHC) testing for all patients with FISH confirmation of IHC 2+ and 3+ and 1-year adjuvant trastuzumab for FISH-positive patients was estimated to {euro} 36 000. The strategy of FISH testing for all patients, with 1-year adjuvant trastuzumab for FISH-positive patients was associated with the longest quality adjusted survival of all evaluated treatment strategies and the cost per QALY gained was estimated to {euro} 41 500. The remaining testing and treatment strategies were dominated.

Conclusion: FISH testing for all patients with 1-year adjuvant trastuzumab for FISH+ patients is a cost-effective treatment option from a societal perspective.

Key words: adjuvant, breast cancer, cost-effectiveness, cost-utility, QALY, trastuzumab

Received for publication March 5, 2007. Revision received September 18, 2007. Accepted for publication September 18, 2007.


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