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Annals of Oncology Advance Access published online on November 30, 2005
Annals of Oncology, doi:10.1093/annonc/mdj101
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© 2005 European Society for Medical Oncology
Received July 19, 2005
Revised October 16, 2005
Accepted November 7, 2005

original article

An economic evaluation of Herceptin® in adjuvant setting: the Breast Cancer International Research Group 006 trial

M. Neyt 1 *, J. Albrecht 1, and V. Cocquyt 2

1 Faculty of Economics and Business Administration, Department of Economics, Ghent University, Ghent, Belgium
2 Faculty of Medicine and Health Sciences, Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium

* To whom correspondence should be addressed.
M. Neyt, E-mail: mattias.neyt{at}ugent.be


  Abstract

Background: Herceptin® (trastuzumab) is a humanized monoclonal antibody that is being tested in the adjuvant setting. Cost implications of using trastuzumab, as administered in the Breast Cancer International Research Group 006 trial, are being calculated. This provides information on the treatment's value for money.

Methods: Standard breast cancer treatment models were set up for different subpopulations according to stage (I, II, III) and menopausal condition (<50 and >50 years). Costs were calculated from the hospital's point of view, using the micro-costing method. Life expectancy data were based on literature. Our comparator was the existing practice. In addition to a sensitivity analysis, a threshold analysis on the prices of trastuzumab and docetaxel was performed to target an acceptable incremental cost-effectiveness ratio.

Results: Treatment costs were {euro}45 034 (doxorubicin and cyclophosphamide -> docetaxel and trastuzumab) or {euro}47 765 (docetaxel, carboplatin and trastuzumab). This was largely (79% and 75%, respectively) attributed to trastuzumab. According to our threshold analysis, an acceptable incremental cost-effectiveness ratio can be reached if health improvements are large enough and/or price discounts are given.

Conclusions: Trastuzumab is a promising but very expensive antibody. With the current pressure on health-care budgets, cost implications of using trastuzumab in adjuvant setting must be calculated before use of the product becomes wide-spread. This provides essential information for price-setting policies and for policy makers considering reimbursement.

Keywords: breast cancer; cost-effectiveness; Herceptin®; threshold analysis; treatment model.
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