Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran

Ansaripour, Amir; Groot, Carin A. Uyl–de; Foroozanfar, Mohammad; Rahimi-Moghadam, S; Redekop, W.K.

doi:10.1016/j.jcpo.2016.05.005

Cited by 3 publications

(13 citation statements)

References 8 publications

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“… # The data obtained from the results of a questionnaire survey. [ 7 ] Y The unit costs obtained from the national health care services tariff 2014 [ 15 ] + The unit cost obtained from the SSO yearly report (2014) [ 13 ] …”

Section: Resultsmentioning

confidence: 99%

“…Outpatient and inpatient data were received anonymously. Lastly, we used the results of a survey of 52 oncologists [ 7 ] to estimate some minor outpatient costs in those rare cases where health care services were not covered by the SSO (e.g., services provided by doctors in their private offices). Data from these three sources were combined and analyzed in three general steps.…”

Section: Methodsmentioning

confidence: 99%

“…If the difference between two or three index dates was more than 3 months, patients were categorized into multiple stages with different index dates, otherwise the health state with the highest confidence was selected. Based on the results of a clinician survey [ 7 ], the index date for each patient with early BC was based on the first date of chemotherapy or radiotherapy (whichever happened earlier) according to possible drug combinations for early BC treatment. The loco-regional BC index date was defined as the first date when the patient received vinorelbine or capecitabine use or single-agent chemotherapy by taxols (docetaxel or paclitaxel).…”

Section: Methodsmentioning

confidence: 99%

“…Treatment costs in the private sector were then calculated based on resource use and converted prices. In certain rare instances, this conversion was also based on the results of a survey of Iranian oncologists [ 7 ]. In all above steps, costs unassociated with BC as well as the costs of uncompleted treatment regimens were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…BC has become one of the most frequent malignancies among Iranian women [ 6 ], which has led to increased efforts to reduce its mortality through prevention or treatment. However, the impact of BC treatment on the overall healthcare budget can be dramatically high because of the costs of medications such as targeted therapy with monoclonal antibodies (trastuzumab); even though the proportion of BC patients with HER2-positive who need to use trastuzumab is approximately 20–25% [ 7 ]. To the best of our knowledge, there is no country-specific cost analysis in Iran that has reported results that can be extrapolated to the general Iranian population.…”

Section: Introductionmentioning

confidence: 99%

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Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran

et al. 2018

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IntroductionPatient registries play an important role in obtaining real-world evidence of the cost-effectiveness of treatments. However, their implementation is costly and sometimes infeasible in many middle-income countries (MICs). We explored the combination of data-mining and a large claims database to estimate the direct healthcare costs of HER2-positive breast cancer (BC) treatment in Iran and the fraction of total costs from trastuzumab use.MethodWe performed a retrospective analysis of claims data from the Iran Social Security Organization, a health insurer which covers approximately 50%(~40 million) of the Iranian population, in the period of 21/03/2011-20/03/2014. A data-mining algorithm using R software and validated using patient dossiers in the Cancer Research Center identified 1295 patients and divided them into the three main HER2-positive breast cancer stages (early, loco-regional and advanced). A payer perspective was used to calculate the absolute and relative direct costs of healthcare services associated with the treatment of HER2-positive breast cancer in the public and private healthcare systems.ResultsThe number of women totaled 802 (early), 125 (loco-regional) and 218 (advanced). The mean age[SD] was 45[10], 46[10] and 48[10] years, respectively, while mean follow-up in all stages was approximately one year. Average costs of direct healthcare care in early, loco-regional and advanced stages were €11,796 (95%CI: €9,356-€12,498), €8,253 (95%CI: €6,843-€10,002), and €17,742 (95%CI: €15,720-€19,505), respectively. Trastuzumab accounted for the largest share of total costs in all three stages (range: 53–76%).ConclusionWherever comprehensive patient registries are infeasible or costly, real-world costs can be estimated through claims databases and data-mining strategies. Using this method, real-world costs have been estimated in Iran. The stage-specific cost estimates derived from this study can be used to perform real-world cost-effectiveness analyses of therapies for HER2-positive BC and support healthcare financing decisions.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran

et al. 2018

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Adjuvant Trastuzumab Therapy for Early HER2-Positive Breast Cancer in Iran: A Cost-Effectiveness and Scenario Analysis for an Optimal Treatment Strategy

2017

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IntroductionClinical guidelines have recommended a 1-year trastuzumab regimen as standard care for early human epidermal growth factor receptor 2 (HER2)-positive breast cancer; however, this recommendation can have a dramatic impact on total drug expenditures in middle-income countries (MICs). We performed a cost-effectiveness analysis from the Iranian healthcare perspective to find an optimum duration of trastuzumab use in Iran.MethodWe compared four treatment strategies comprising chemotherapy and varying durations of trastuzumab use (no trastuzumab, 6, 9 months, and 1 year), and a Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the strategies. We then examined the cost effectiveness of the strategies at different willingness-to-pay (WTP) thresholds and ages at onset of treatment.ResultsIncremental costs (versus no trastuzumab) were €8826 (6 months), €13,808 (9 months) and €18,588 (12 months), while incremental quality-adjusted life-years (QALYs) were 0.65 (6 months), 0.87 (9 months) and 1.14 (12 months). At a threshold of 3 × gross domestic product (GDP)/capita (€21,000/QALY) and for patients younger than 59 years, the 6-month protocol was most likely to be cost effective (probability of 42%). At a threshold of 4 × GDP/capita (€28,000/QALY), the 6-month and 1-year regimens were essentially equal in cost effectiveness (37 and 35%, respectively). At this WTP threshold, the 6-month and 1-year regimens were optimal strategies only for patients up to 66 and 44 years of age, respectively.ConclusionIn contrast to clinical guidelines, 6 months of trastuzumab may be the most cost-effective option for Iran. The lower absolute WTP threshold and lower life expectancy compared with high-income countries are two crucial parameters in the cost effectiveness of interventions in MICs. It is therefore necessary to strike a balance between maximum population health and maintaining affordability in these countries.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0557-6) contains supplementary material, which is available to authorized users.

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Trastuzumab uptake in HER2-positive breast cancer patients: a systematic review and meta-analysis of observational studies

Martin

Downing

Cochrane

et al. 2018

Critical Reviews in Oncology/Hematology

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Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran

Cited by 3 publications

References 8 publications

Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran

Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran

Adjuvant Trastuzumab Therapy for Early HER2-Positive Breast Cancer in Iran: A Cost-Effectiveness and Scenario Analysis for an Optimal Treatment Strategy

Trastuzumab uptake in HER2-positive breast cancer patients: a systematic review and meta-analysis of observational studies

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