N Engl J Med

N Engl J Med. published in a systematic review. Real cost data were obtained from the British Columbia Cancer Agency and were evaluated from a payer perspective. Costs and utilities were discounted at 5% per year, respectively, for a 28-year time horizon. Results. In the base case analysis, treatment with a 12-month adjuvant trastuzumab regimen resulted in a gain of 1 1.38 quality-adjusted life years or 1.17 life years gained at a cost of $18,133 per patient. Thus, the 5-Methoxytryptophol cost per QALY gained for the base case is $13,095. Cost per LYG is $15,492. Conclusions. Over the long term, treatment of HER-2/neu mutation positive breast cancer with a 12-month protocol of trastuzumab in the adjuvant setting is predicted to be cost-effective in a Canadian context. .0001) and a 33% relative increase in overall survival (= .015) in patients with early and operable HER-2/neu-positive breast cancer [6]. Cardiac dysfunction can be associated with the use of trastuzumab, necessitating the use of cardiac monitoring prior to treatment initiation and at 3-month intervals during therapy. In the NSABP/NCCTG analysis, the incidence of New York Heart Association class III or IV congestive heart failure or death from cardiac causes was higher in the trastuzumab arm at a 4.1% incidence rate than the standard chemotherapy-only arms at a 0.8% incidence rate [6]. The use of trastuzumab in the adjuvant setting was approved by the British Columbia Cancer Agency (BCCA) in July 2005. Since that time, trastuzumab has represented approximately 15% of BCCA’s $100 million drug budget. Although there is increasing evidence of a substantial clinical benefit of trastuzumab in the adjuvant setting, the high cost of this therapy necessitates an analysis of its cost-effectiveness. To date, no published studies have assessed the cost-effectiveness of this drug from a Canadian perspective, or using real-world data, nor have they accounted for patients who may receive trastuzumab in both the adjuvant and metastatic settings [7C9]. The aim of this study was to develop a Markov model to estimate the incremental cost-effectiveness of adjuvant trastuzumab for operable, HER-2/neu-positive early breast cancer, accounting for the differences in costs and health outcomes associated with trastuzumab and standard of care treatments in the adjuvant and metastatic settings. Materials and Methods With use of R-Graphical User Interface (R-Gui), a decision-analysis model for HER-2/neu-positive breast cancers was developed to evaluate the cost-effectiveness of a 12-month adjuvant trastuzumab protocol (presented in Figure 1) compared with that of standard chemotherapy. Selected model parameters are presented in Table 1 and complete data in the Supplemental Online Appendix. The model used a Markov transition process with 10 health states, was created with a 3-month cycle length, and was run on a 28-year time horizon. Costs and quality-of-life values assigned to each state were derived from pre-existing literature and BCCA databases. Results Rabbit Polyclonal to PDK1 (phospho-Tyr9) are presented as incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life 5-Methoxytryptophol year (QALY) gained and cost per life year gained (LYG). (The term LYG 5-Methoxytryptophol refers to the cost of prolonging a patient’s 5-Methoxytryptophol life for a single year, attributable to a particular intervention. QALYs gained can then be computed as the duration of survival multiplied by a utility weight that represents the quality of health experienced during that time period.) The model is notably more complex than those previously published, to account for the possibility of the use of trastuzumab in both the adjuvant and metastatic settings [7C9]. Open in a separate window Figure 1. Markov model. Note: Arrows indicate transitions. Arrows that curve back to the same state represent patients who remained in the health state in question 5-Methoxytryptophol for more the one 3-month cycle. Abbreviation: CHF, congestive heart failure. Table 1. Key model parameters Open in a separate window The model was applied to a hypothetical patient population similar to those used in recently published phase III clinical trials [5, 6]: one thousand 50-year-old women with.

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