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Proffered paper session - Breast cancer, early stage

5643 - PERSEPHONE: 6 versus 12 months (m) of adjuvant trastuzumab in patients (pts) with HER2 positive (+) early breast cancer (EBC): Cost effectiveness analysis results

Date

19 Oct 2018

Session

Proffered paper session - Breast cancer, early stage

Presenters

Peter Hall

Authors

C. Hulme1, P. Hall2, B. Shinkins1, F. Chehadah1, C. McCabe3, L. Hiller4, J. Dunn4, H.M. Earl5

Author affiliations

  • 1 Academic Unit Of Health Economics, University of Leeds-Institute of Health Sciences, LS2 9LJ - Leeds/GB
  • 2 Edinburgh Cancer Research Uk-, University of Edinburgh, EH4 2XR - Edinburgh/GB
  • 3 Faculty Of Medicine And Dentistry, University of Alberta, AB T6G 1C9 - Edmonton/CA
  • 4 Warwick Clinical Trials Unit, University of Warwick, CV4 7AL - Warwick/GB
  • 5 Department Of Oncology, Cambridge University Hospitals NHS Foundation Trust - Addenbrooke's Hospital, CB2 0QQ - Cambridge/GB
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Abstract 5643

Background

Adjuvant trastuzumab has significantly improved outcomes for HER2+ EBC, using the 12m duration empirically adopted from pivotal registration trials. Given an annual per patient cost of trastuzumab treatment of over £30,000 (Euro35,000), a shorter duration has the potential to improve cost-effectiveness if efficacy is maintained.

Methods

The cost-effectiveness analysis was based on data from the PERSEPHONE trial, a phase III non-inferiority RCT comparing 6 to 12m Trastuzumab, the largest reduced-duration non-inferiority trial internationally. A landmark analysis 6 months into treatment was conducted, comparing costs and quality of life throughout follow-up (6m – 24m post treatment start). Multiple imputation was required to impute incomplete quality of life data. Quality Adjusted Life Years (QALYs) were adjusted for differences at baseline. Uncertainty is estimated using the non-parametric bootstrap method.

Results

4009 patients were disease free at 6m (6m: n=2000, 12m: n=2009) and therefore eligible for the analysis. Of these, 250 individuals (6m: n=132, 12m: n=118) had either no returned PQ forms or no returned treatment forms and therefore were excluded from the analysis.
The average costs for an individual in the 6m arm and 12 month arm were £2,538.64 (95% CI: £2,383.38 - £2700.72) and £12,333.83 (95% CI: £12,098.58 - £12,562.27), respectively, giving an average cost saving of £9,793.25 (95% CI: £9,515.86 - £10,071.64) per individual. Trastuzumab treatment and administration accounted for £9,699.58 (95% CI: £9,436.20 - £9.954.67) of this cost saving, the remaining arising from cardiac assessment and treatment costs and inpatient days. The average QALYs for an individual in the 6m arm and 12 month arm were 1.146 (95% CI: 1.131 – 1.161) and 1.128 (95% CI: 1.113 – 1.144), respectively, giving an average QALY difference of 0.018 (95% CI: -0.003 – 0.039). Thus, the 6m arm dominated with a probability of being cost effective of 100%.

Conclusions

6m of trastuzumab was shown to be cost effective compared to 12m with cost-savings and no evidence of a detriment to quality of life.

Clinical trial identification

Registry Name: ISRCTN Register. Registration Number: 52968807

Editorial Acknowledgement

None

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