Contribution of trastuzumab to the prognostic improvement of HER2-positive early breast cancer in Spain: an estimation of life years and disease-free life years gained since its approval
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Eva Ciruelos1, Emilio Alba2, Rafael López3, Anna Lluch4, Miguel Martín5, Isabel Arroyo6, Beatriz Navarro7, David Carcedo8, Ramón Colomer9 and Joan Albanell10
1 Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
2 Clinical Oncology Unit, Hospitales Universitarios Regional y Virgen de la Victoria; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
3 Department of Medical Oncology, Hospital Clínico Universitario e Instituto de Investigación Sanitaria-CIBERONC, Santiago de Compostela, Spain
4 Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Health Research Institute INCLIVA, University of Valencia, The Centre of Networked Biomedical Cancer Research (CIBERONC), Valencia, Spain
5 Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, GEICAM, CIBERONC, Madrid, Spain
6 Department of Payer Evidence and Health Economics, Roche Pharma, Madrid, Spain
7 Medical Department, Roche Pharma, Madrid, Spain
8 Oblikue Consulting, Barcelona, Spain
9 Medical Oncology Service, Hospital Universitario La Princesa, Madrid, Spain
10 Medical Oncology Service, Hospital del Mar, IMIM, Universitat Pompeu Fabra, The Centre of Networked Biomedical Cancer Research (CIBERONC), and Centro Oncológico Clara Campal-HM Delfos, Barcelona, Spain
Keywords: early breast cancer; trastuzumab; life-years; economics; Spain
Received: February 12, 2019 Accepted: June 05, 2019 Published: July 02, 2019
Introduction: Trastuzumab has become the standard treatment for both HER2-positive early and metastatic breast cancer (HER2+ eBC or mBC) since its approval. The objective of the study is to estimate the benefit of adjuvant trastuzumab in the treatment of patients with HER2+ eBC in terms of life years gained (LYG) and disease-free life years gained (DFLYG) since its approval in Spain in 2006.
Results: 35,851 women make up the cohorts from 2006 to 2017. In the T (trastuzumab)+CT (chemotherapy) scenario, the sum of life years was 605,358 (525,964 disease-free) versus 564,137 (489,916 disease-free) in the CT scenario, resulting in 41,221 LYG (36,048 disease-free) due to trastuzumab. The general population for the same age range would have generated 704,331 LY. The estimated incremental cost was 880.43 million€ (€24,558.13 per patient) from 2006 to 2035. The incremental cost-effectiveness ratios obtained were €20,644 and €23,960 per LYG and DFLYG, respectively.
Methods: An epidemiological model was developed with a time horizon until 2035 and a 3% discount rate. The model compared two scenarios, with and without trastuzumab as adjuvant therapy. The effectiveness data to model the survival curves were obtained from BCIRG 006 study and direct costs were included.
Conclusions: Adjuvant trastuzumab has substantially improved the survival of patients with HER2+ eBC, contributing over 41,000 LYG to Spanish society (over 36,000 DFLYG) in a cost-effective manner. However, the sum of LYG with trastuzumab is still far from the LY estimated for the general population, supporting the need of further advances in HER2+ eBC.
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