COST-EFFECTIVENESS ANALYSIS OF BREAST CANCER PATIENTS USING THE HERCEPTIN

Autor: Hsiao-Wei Chen, 陳筱瑋
Rok vydání: 2014
Druh dokumentu: 學位論文 ; thesis
Popis: 102
Background For the number of patients dying of cancer in 2012, 16.5% of them are female patients with breast cancer. Breast cancer is the 4th leading cause of death among the top 10 leading causes of cancer death. Since 2010, National Health Insurance (NHI) in Taiwan has started to cover the adjuvant use of Trastuzumab (Herceptin) in patients with early stages of breast cancer. To date, the cost-effectiveness analysis on this drug has not been evaluated. Therefore, it is necessary to assess the cost-effectiveness of use of Herceptin in patients with early stages of breast cancer in Taiwan as measured by the actual NHI costs. It is hoped that the research results may be used as reference for the continuous NHI coverage. Methods This study used Markov Model to compare the cost-effectiveness of patients who aged 50 in early stage of HER2-overexpressive breast cancer received adjuvant therapy at least one year after surgery or chemotherapy with those who did not receive adjuvant therapy of Herceptin. The cycle length of the assessment was one year. The costs were calculated according to the total expenditure from the NHI database. The transition probability of disease progression was derived from relevant literature. 3% discount rate was used in the cost and utility to perform the cost-effectiveness analysis. Results At the discount rate of 3%, the quality-adjusted life-years (QALYs) gained by the patients receiving the adjuvant therapy of Herceptin at 5-year, 10-year, 15-year, and overall lifetime study periods were 2.896, 4.164, 4.667 and 4.984, respectively. Compared with the QALYs gained by the patient receiving the non-adjuvant therapy of Herceptin (1.947、2.907、3.216 and 3.353), the additional QALYs gained by those who did were 0.949, 1.257, 1.451 and 1.631, respectively. In addition, the incremental cost-effectiveness ratios (ICERs) were NTD$1,414,290, NTD$1,675,672, NTD$1,713,805 and NTD$1,711,485 per QALY, respectively. Conclusion The ICERs of the patients with early stages of breast cancer aged 50 who received the adjuvant therapy of Herceptin, at the discount rate of 3%, were all lower than the willing to pay (WTP) NTD$1,805,130 set up by this study, regardless of the length of study period. Therefore, the adjuvant use of Herceptin in patients with early stages of breast cancer after surgery or chemotherapy is a cost-effective therapeutic strategy.
Databáze: Networked Digital Library of Theses & Dissertations
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