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Human epidermal growth factor receptor 2 expression in early breast cancer patients: a Swiss cost-effectiveness analysis of different predictive assay strategies

Blank, Patricia ; Schwenkglenks, Matthias ; Moch, Holger ; Szucs, Thomas

In: Breast Cancer Research and Treatment, 2010, vol. 124, no. 2, p. 497-507

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    Titre
    • Human epidermal growth factor receptor 2 expression in early breast cancer patients: a Swiss cost-effectiveness analysis of different predictive assay strategies
    Auteur
    • Blank, Patricia. Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
    • Schwenkglenks, Matthias. Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
    • Moch, Holger. Competence Center for Systems Physiology and Metabolic Diseases (CC-SPMD), Zurich, Switzerland
    • Szucs, Thomas. European Center of Pharmaceutical Medicine, University of Basel, Klingelberstrasse 61, 4056, Basel, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Breast Cancer Research and Treatment, 2010, vol. 124, no. 2, p. 497-507. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:314032
    Summary
    Trastuzumab has conferred significant clinical benefits in HER-2-positive breast carcinomas. HER-2 status is determined by immunohistochemistry (IHC) and/or fluorescence in situ hybridisation (FISH), but appropriate assessment of HER2 status remains subject to considerable debate. Data on the health economic impact of HER-2 test strategies are limited. A life-long Markov state transition model was used to assess costs and effectiveness of HER-2 assay strategies (based on IHC, FISH, both combined or FISH confirmation of IHC2+) for a hypothetical cohort of early breast cancer patients from the perspective of the Swiss health system. We compared clinically relevant strategies of predictive testing and subsequent trastuzumab treatment of HER-2-positive patients only. FISH testing was the most cost-effective strategy with an incremental cost-effectiveness ratio of €12,245 per additional quality-adjusted life-year (QALY) gained, compared to no trastuzumab treatment. The next best strategy was parallel IHC and FISH, with costs of €400,154/QALY gained compared to FISH alone. FISH as primary HER-2 testing modality remained the preferred option in deterministic and probabilistic sensitivity analysis. Predictive testing to identify adjuvant breast cancer patients who benefit from trastuzumab treatment is a clinical and economic necessity. Our model identifies FISH as the most cost-effective approach