Depending on the disease characteristics and age of a women with early stage but aggressive breast cancer, the cost-effectiveness of Herceptin (trastuzumab) may vary widely, according to a recent study by researchers in New Zealand.
The results were reported in “Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis,” published in PLOS Medicine.
Herceptin is a monoclonal antibody that targets the extracellular domain of the human epidermal growth factor receptor 2 (HER2) protein, an aggressive type of breast cancer. It is known to improve survival in the metastatic setting when used in combination with chemotherapy.
Researchers used a computer model to simulate the life courses of breast cancer patients, comparing a 12-month regimen of those under Herceptin plus chemo to those under chemotherapy along, to estimate health gains, costs, and cost-effectiveness of the combination treatment.
“We found that the cost-effectiveness of Herceptin was markedly better for women with a worse-prognosis subtype of breast cancer compared to a better-prognosis subtype. These results may help inform future resource allocation decisions,” William Leung, the study’s lead author, with the Department of Public Health at the University of Otago in Wellington, said in a press release.
Data collected from cancer patients New Zealand and elsewhere showed that patients who were negative for the estrogen receptor (ER) and progesterone receptor (PR), the worst prognosis subtype, had a 2.3-fold increase in their quality-adjusted life-years, compared to those who were ER+/PR+, the best prognosis subtype.
“In this age of precision medicine, i.e. targeting medications by patient characteristics and disease subtypes, it seems odd and outdated that our funding mechanisms for these diseases are still very blunt,” said Tony Blakely, the study’s co-author, noting that treatment cost-effectiveness can vary greatly by disease prognosis and background morbidity.
“If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]–adjusted …), our study suggests that trastuzumab … may not be cost-effective for ER+ (which are 61% of all) node-positive HER2+ early breast cancer patients but cost-effective for ER−/PR− subtypes (37% of all cases) to age 69,” the researchers concluded.
And, they added: “Resource allocation and licensing of subsidised therapies such as trastuzumab should consider demographic and clinical heterogeneity; there is currently a profound disconnect between how funding decisions are made (largely agnostic to heterogeneity) and the principles of personalised medicine.”
Herceptin is approved by the U.S. Food and Drug Administration as an adjuvant treatment for women with node-positive, HER2-overexpressing breast cancer.
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