OBJECTIVES: To evaluate the cost-effectiveness of adjuvant trastuzumab in six Latin American (LA) countries (Argentina, Bolivia, Brazil, Chile, Perú and Uruguay) in early HER2-positive breast cancer. METHODS: A Markov model was designed to evaluate life years, quality adjusted life years (QALYs) and costs from a health sector perspective. A systematic search on effectiveness, local epidemiology and costs was undertaken to populate the model. Two face to face meetings of countries teams were held to agree on model structure, required parameters, and a costing template to use a common methodology. Two main transition probability scenarios for the no-trastuzumab cohort were built and calibrated, one using trial data (TD) and one using local/Globocan data (LD) in order to better fit local cancer prognosis. The base case scenario was with 55-year-old women, and used a 5% discount rate. Currency used was 2010 US dollars ($). RESULTS: Trastuzumab benefits ranged from 0.9 to 1.1 QALY in the TD scenario, and between 1.5 to 2.6 QALY in the LD scenario. Incremental discounted costs of the trastuzumab strategy ranged from $39,000 to $68,000 in the TD scenario, and $40,000 to $66,000 in the LD scenario. Incremental cost-effectiveness ratios ranged from 39,000 to 60,000 $/QALY in the TD scenario, and between 21,000 and 40,000 $/QALY in the LD scenario. CONCLUSIONS: Using the usually cited 3GDP threshold, these study results suggest that adjuvant trastuzumab for early breast cancer may not be cost-effective in most situations in the participant LA countries. Since trastuzumab was shown to be cost-effective in many studies conducted in developed countries, our results highlight the urgent need to evaluate many of the other new “biologic” treatments for cancer and other diseases, as many of them are currently used in LA but have shown, in other settings, much more unfavourable cost-effectiveness profiles than trastuzumab.
Pichon-Riviere, A., Augustovski, F., Garay, O. U., Buendia, J., Rodríguez, A., Vallejos, C., … Oliveira, C. (2011). CN1 Cost-Effectiveness of Trastuzumab in the Adjuvant Treatment of Early Breast Cancer in Six Latin American Countries. Value in Health, 14(7), A538. https://doi.org/10.1016/j.jval.2011.08.1537