Cost and cost-effectiveness of adjuvant trastuzumab in the real world setting: A study of the Southeast Netherlands Breast Cancer Consortium

// Shanly C. Seferina 1,2 , Bram L.T. Ramaekers 8 , Maaike de Boer 1,2 , M. Wouter Dercksen 3 , Franchette van den Berkmortel 4 , Roel J.W. van Kampen 1,5 , Agnes J. van de Wouw 6 , Adri C. Voogd 1,2,7 , Vivianne C.G. Tjan Heijnen 1,2 , Manuela A. Joore 8,9 1 Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands 2 GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands 3 Department of Internal Medicine, Maxima Medical Center, Veldhoven, The Netherlands 4 Department of Internal Medicine, Zuyderland Medical Center, Heerlen, The Netherlands 5 Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands 6 Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands 7 Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands 8 Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands 9 School for Public Health and Primary Care, Maastricht University Medical Center, The Netherlands Correspondence to: Manuela A. Joore, email: // Keywords : trastuzumab, cost-effectiveness, early breast cancer, real-world, Markov model Received : January 23, 2017 Accepted : March 10, 2017 Published : April 09, 2017 Abstract Background: We assessed the real world costs and cost-effectiveness of the addition of trastuzumab in HER2 positive early breast cancer compared to chemotherapy alone in the Dutch daily practice as opposed to the results based on trial data and based on a subset of patients that were treated according to the guidelines. Patients and Methods: In a cohort study, we included all patients with stage I-III invasive breast cancer treated with curative intent in 5 Dutch hospitals between 2005 and 2007 ( n =2684).We assessed three scenarios: a real-world scenario, a trial scenario and a guideline scenario, with costs and effectiveness based on either the cohort study, the published trials or the guidelines. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were constructed. Results: Costs were €243,216 and €239,657 for trastuzumab and no trastuzumab for the real world scenario, €224,443 and €218,948 for the guideline scenario and €253,666 and €265,116 for the trial scenario. The QALYs were 0.827, 0.861, 0.993 for the real world, guideline and trial scenario. The corresponding ICERs were €4,304, €6,382 and dominance, respectively. CEACs showed that the probability that trastuzumab is cost-effective is ≥99% in each scenario. Conclusion: Adjuvant trastuzumab in the real world can be considered cost-effective.