Trastuzumab in adjuvant breast cancer therapy. A model based cost-effectiveness analysis

Trastuzumab has shown activity in early breast cancer patients that overexpress HER2. Significant resources have to be allocated to finance this therapy, underlining the need for cost-effectiveness analysis. A model was set up, societal costs were calculated and the discount rate was 3%. Life expectancy data were based on the literature and prolonged according to qualified guess (10% and 20% absolute improvement in overall survival (OS)). The comparator was the FEC100 regimen. The median additional health care cost per patient treated was EURO33597. The yielding cost per life year gained (LYG) was 15 341 with a 20% improved OS and EURO35947 with 10% improved OS. The corresponding net health care cost per quality adjusted life year (QALY) was EURO19176 and EURO44934. Including all resource use the figures were EURO8148 and EURO30290 per LYG. Sensitivity analyses documented survival gain, price of trastuzumab, production gain and discount rate to be the major factors influencing cost-effectiveness ratio. Trastuzumab is indicated cost effective in Norway.