タイラ　ナルト   Naruto Taira   平　成人    所属   川崎医科大学  医学部 臨床医学　乳腺甲状腺外科学    職種   教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Cost-Effectiveness of Trastuzumab With or Without Chemotherapy as Adjuvant Therapy in HER2-Positive Elderly Breast Cancer Patients: A Randomized, Open-Label Clinical Trial, the RESPECT Trial.
掲載誌名	正式名：Clinical drug investigation 略　 称：Clin Drug Investig ISSNコード：11791918/11732563
掲載区分	国外
巻・号・頁	42(3),pp.253-262
著者・共著者	Takumoto Yuki, Shiroiwa Takeru, Shimozuma Kojiro, Iwata Hiroji, Takahashi Masato, Baba Shinichi, Kobayashi Kokoro, Hagiwara Yasuhiro, Kawahara Takuya, Uemura Yukari, Mukai Hirofumi, Taira Naruto, Sawaki Masataka
発行年月	2022/03
概要	BACKGROUND AND OBJECTIVE:Trastuzumab is a standard care as adjuvant chemotherapy (AdjCT) for patients with human epidermal growth factor receptor 2 (HER2)-positive primary breast cancer (BC) in Japan. However, no reports have evaluated its economics for patients with HER2-positive BC over 70 years of age. The objective of this study was to evaluate the cost-effectiveness of HER2-targeted trastuzumab + chemotherapy in Japan, comparing it with trastuzumab monotherapy.METHODS:A three-state-partitioned survival model was developed to evaluate the cost-effectiveness of trastuzumab + chemotherapy versus trastuzumab monotherapy for AdjCT in elderly patients with HER2-positive BC. We derived the efficacy data, utilities, and costs of both arms from individual patient data in the RESPECT trial (NCT01104935) and published studies. The costs and quality-adjusted life years (QALYs) were discounted at 2% per annum using a payer perspective. The respective cost estimates were reported in 2019 Japanese Yen (JPY) or US dollars (US$). The primary outcome was the incremental cost-effectiveness ratio (ICER). We assured robustness with deterministic and probabilistic sensitivity analyses.RESULTS:The cost per patient for trastuzumab + chemotherapy was JPY 14.6 million (US$137,000), and their QALYs were 9.308, compared with JPY 14.2 million (US$131,000) and 9.101, respectively, for trastuzumab monotherapy. The ICER of trastuzumab + chemotherapy versus trastuzumab monotherapy was JPY 2.7 milllion/QALY (US$17,200/QALY). The ICER for trastuzumab with chemotherapy varied from "Dominant" to "Dominated" in one-way sensitivity analysis.CONCLUSIONS:The base-case analysis suggests that AdjCT with trastuzumab + chemotherapy is likely to be a cost-effective choice for patients with HER2-positive BC aged 70 years or older. However, the sensitivity analysis suggested uncertainty regarding the cost-effectiveness of trastuzumab + chemotherapy.
DOI	10.1007/s40261-022-01124-y
PMID	35233755