Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-25T02:06:37.371Z Has data issue: false hasContentIssue false
  • English
  • Français

Budget impact analysis of trastuzumab in early breast cancer: A hospital district perspective

Published online by Cambridge University Press:  15 April 2010

Timo T. Purmonen ,
Päivi K. Auvinen  and
Janne A. Martikainen
Timo T. Purmonen
Affiliation:
University of Kuopio
Päivi K. Auvinen
Affiliation:
Kuopio University Hospital
Janne A. Martikainen
Affiliation:
University of Kuopio
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint.

Methods: The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results.

Results: Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was €1.3 million. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease.

Conclusions: Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

Keywords

Breast cancerBudget impact analysisComputer simulationMedical economicsTrastuzumab
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 2 , April 2010 , pp. 163 - 169
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Department of Pathology, Kuopio University Hospital. Statistics of breast cancer patients during 2006–2008; Systematic evaluation using Chromogenic in situ hybridization (CISH). Kuopio: Department of Pathology, Kuopio University Hospital.Google Scholar
2. Drucker, A, Skedgel, C, Virik, K, et al. The cost burden of trastuzumab and bevacizumab therapy for solid tumours in Canada. Curr Oncol. 2008;15:136–142.CrossRefGoogle ScholarPubMed
3. Finnish Cancer Registry. http://www.cancerregistry.fi (accessed April 8, 2008).Google Scholar
4. Herceptin EMEA (trastuzumab). [Summary of product characteristics] European Public Assessment Report. http://www.emea.europa.eu/humandocs/Humans/EPAR/herceptin/herceptin.htm (accessed October 2, 2008).Google Scholar
5. Häkkinen, U. The impact of changes in Finland's health care system. Health Econ. 2005;14:S101–S118.CrossRefGoogle ScholarPubMed
6. Joensuu, H, Isola, J, Lundin, M, et al. Amplification of erbB2 and erbB2 expression are superior to estrogen receptor status as risk factors for distant recurrence in pT1N0M0 breast cancer: A nationwide population based study. Clin Cancer Res. 2003;9:923–930.Google ScholarPubMed
7. Joensuu, H, Kellokumpu-Lehtinen, P, Bono, P, et al. Adjuvant Docetaxel or Vinorelbine with or without Trastuzumab for breast cancer. N Engl J Med. 2006;354:809–820.Google Scholar
8. Liberato, NL, Marchetti, M, Barosi, G. Cost effectiveness of adjuvant trastuzumab in human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2007;25:625–633.CrossRefGoogle ScholarPubMed
9. Mauskopf, JA, Sullivan, SD, Annemans, L, et al. Principles of good practice for budget impact analysis: Report of the ISPOR Task Force on good research practices: Budget impact analysis. Value Health. 2007;10:336–347.CrossRefGoogle ScholarPubMed
10. McKeage, K, Lyseng-Williamson, K. Trastuzumab: A pharmacoeconomic review of its use in early breast cancer. Pharmacoeconomics. 2008;26:699–719.CrossRefGoogle ScholarPubMed
11. Neyt, M, Huybrechts, M, Hulstaert, F, Vrijens, F, Ramaekers, D. Trastuzumab in early stage breast cancer: A cost-effectiveness analysis for Belgium. Health Policy. 2008;87:146–159.CrossRefGoogle ScholarPubMed
12. Niezen, MG, Stolk, EA, Steenhoek, A, Uyl-De Groot, CA. Inequalities in oncology care: Economic consequences of high cost drugs. Eur J Cancer. 2006;42:2887–2892.Google Scholar
13. Niezen, MG, de Bont, A, Busschbach, JJ, Cohen, JP, Stolk, EA. Finding legitimacy for the role of Budget impact in drug reimbursement decisions. Int J Technol Assess Health Care. 2009;25:49–55.Google Scholar
14. Owens, MA, Horten, BC, Da Silva, MM. Her2 amplification ratios by fluorescence in situ hybridization and correlation with immunohistochemisty in a cohort of 6556 breast cancer tissues. Clin Breast Cancer. 2004;5:63–69.CrossRefGoogle Scholar
15. Perez, EA, Romond, EH, Suman, VJ, et al. Updated results of the combined analysis of NCCTG N9831 and NSABP B-31 adjuvant chemotherapy with/without trastuzumab in patients with HER2-positive breast cancer. J Clin Oncol. 2007;25 (Suppl):512.CrossRefGoogle Scholar
16. Piccart-Gebhart, MJ, Procter, M, Leyland-Jones, B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353:1659–1672.Google Scholar
17. Romond, EH, Perez, EA, Bryant, J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673–1684.Google Scholar
18. Sendi, PP, Briggs, A. Affordability and cost-effectiveness: Decision-making on the cost-effectiveness plane. Health Econ. 2001;10:675–680.CrossRefGoogle ScholarPubMed
19. Shiroiwa, T, Fukuda, T, Shimozuma, K, Ohashi, Y, Tsutani, K. The model-based cost-effectiveness analysis of 1-year adjuvant trastuzumab treatment: Based on 2-year follow-up HERA trial data. Breast Cancer Res Treat. 2008;109:559–566.Google Scholar
20. Skedgel, C, Rayson, D, Younis, T. Accounting for improved outcomes in budget impact analyses: Adjuvant trastuzumab in HER2/neu-positive breast cancer. J Clin Oncol. 2008;26 (Suppl):6573.CrossRefGoogle Scholar
21. Slamon, D, Godolphin, W, Jones, LA, et al. Studies of the HER-2/neu proto-oncogene in human breast and ovarian cancer. Science. 1989;244:707–712.Google Scholar
22. Slamon, D, Eiermann, W, Robert, N, et al. Phase III randomized trial comparing Doxorubicin and cyclophosphamide followed by docetaxel (AC T) with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (AC TH) with docetaxel, carboplatin and trastuzumab (TCH) in HER2 positive early breast cancer patients: BCIRG 006 study. Breast Cancer Res Treat. 2005;100 (5S): (abstract 1).Google Scholar
23. Slamon, D, Eiermann, W, Robert, N et al. , BCIRG 006: 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab with docetaxel, carboplatin and trastuzumab in Her2neu positive early breast cancer patients. Presented at the 2006 San Antonio Breast Cancer Symposium, San Antonio, Texas, December 14–17, 2006.Google Scholar
24. Smith, I, Procter, M, Gelber, RD, et al. 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: A randomised controlled trial. Lancet. 2007;369:29–36.Google Scholar
25. Statistics Finland. Causes of death (2007). http://www.stat.fi (accessed December 12, 2008).Google Scholar
26. Younis, T, Skedgel, C. Is trastuzumab a cost-effective treatment for breast cancer? Expert Rev Pharmacoecon Outcomes Res. 2008;8:433–442.Google Scholar
Supplementary material: File

Purmonen et al. supplementary material

Supplementary tables

Download Purmonen et al. supplementary material(File)
File 24.2 KB