Cancer Research Lab

Despite carrying a price tag of $50,000 or more for 1 year of treatment, trastuzumab (Herceptin) is cost-effective as adjuvant therapy for early-stage HER2-positive breast cancer, according to the findings of two studies appearing in the Journal of Clinical Oncology for February 20.

“In the subgroup of patients with HER2-positive, high-risk breast cancers, trastuzumab enhances the clinical advantage of adjuvant chemotherapy at a cost generally considered appropriate for the added value that trastuzumab produced,” Dr. Nicola Lucio Liberato, lead author of the first study, said in a statement.

Dr. Liberato, from Ospedale Civile “C. Mira” in Pavia, Italy, and colleagues used a Markov model to asses the cost-effectiveness of 12-month trastuzumab adjuvant therapy in women with high-risk HER2-positive early breast cancer. Probabilities of disease recurrence and survival were derived from the National Surgical Adjuvant Breast and Bowel Project B-31 and other trials.

Adjuvant therapy with trastuzumab increases life expectancy by 1.54 quality-adjusted life years (QALYs) in the target patient group, the report indicates. The cost per life-year saved was between 14,861 and 18,970 euros, which is on par or lower than the costs associated with other adjuvant therapies.

In the second study, Dr. Allison W. Kurian, from Stanford University School of Medicine in California, and colleagues used a Markov model to compare the cost-effectiveness of chemotherapy alone, an anthracycline-based regimen plus trastuzumab, and a non-anthracycline regimen plus trastuzumab.

The authors found that the anthracycline-based therapy plus trastuzumab carries an incremental cost-effectiveness ratio of $39,982 per QALY, a cost that compares favorably with that of other therapies for early breast cancer. The non-anthracycline-based trastuzumab regimen was less effective and more costly.

If the trastuzumab fails to provide benefit after 4 years of treatment, the incremental cost-effectiveness ratios of each trastuzumab regimen exceed $100,000 per QALY.

“Some people may be surprised” by the results, Dr. Kurian said in a statement. “Our findings show that in a specific treatment situation — early in the course of the disease — even an expensive therapy like trastuzumab can provide large enough health benefits that it represents a good value.”