Economic evaluation of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer: systematic review and quality assessment

Abstract

Introduction: As the availability of new economic evaluations (EE) on adjuvant trastuzumab therapy for early-stage breast cancer (EBC) with HER2-positive since last search and other EEs missed warrant a more extensive review, this study aimed to systematically review EEs of adjuvant trastuzumab compared with chemotherapy alone for HER2-positive EBC. Area covered: The search was performed in February 2019 using MEDLINE and Scopus. Reviewers independently selected studies based on eligibility criteria, extracted data, assessed quality of reporting, and appraised quality of data sources. Expert opinion: 22 studies were included which were from high-income (HICs) and upper-middle income countries (UMICs). Incremental cost-effectiveness ratios (ICERs) from HICs were within their costeffectiveness thresholds and ranged from 6,018 to 78,929 USD per quality-adjusted life year (QALY) gained. ICERs from UMICs mostly exceeded their thresholds ranging from 3,526 to 174,901 USD per QALY gained. Evidence shows cost-effectiveness of trastuzumab for HER2-positive EBC in HICs. There were no methodological variations. The extent and adequacy of reporting were high. The quality of data sources was moderate to high. The quality of future EEs can be improved by enhancing the reporting quality, by using context-based data and real-world efficacy data, which would impact cost-effectiveness.

Systematic Review on the Use of Biosimilars of Trastuzumab in HER2+ Breast Cancer

“…Regarding the combined administration of biosimilars for HER2+ MBC, Diaby et al showed that trastuzumab with docetaxel as the first line of treatment represented the most cost-effective strategy among the four regimens evaluated in patients with HER2+ MBC [ 72 ]. Genuino et al [ 73 ], in a recent systematic review, evaluated the adjuvant administration of trastuzumab in comparison with chemotherapy alone in patients with HER2+ EBC. They analyzed data from 22 studies from high- and middle-income countries, respectively.…”

Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

“…Indeed, economic effectiveness results from HICs do not translate to LMICs, and even countries within the same income level may have different results depending on the price of medications and availability of real-world data. 44 An example would be the case for pertuzumab. In the HER2-positive adjuvant setting, pertuzumab scored a level C on the Magnitude of Clinical Benefit Scale, which indicates low clinical benefit, whereas in the metastatic setting, it scored a level 4, which indicates a substantial clinical benefit.…”

Breast cancer methodology for maximization of resources currently used in Mexican centers

“…Specifically, it is sought to present a practical methodology to contrast the clinical impact against the economic impact of patient service management in their different stages in the line of treatment. In recent years, models regarding the cost-effectiveness of breast cancer individual treatments have been made [7][8][9][10][11][12][13] as well as reviews analyzing new therapies' cost-efficiency [14][15][16] . However, during open research, only the study made by Wong et al 16 was found to be like ours.…”