the bean-counters are warming up!calculaeing cost-savings limiting herceptin 2 3 mos.

Lani · 09-01-2007, 11:04 AM

Ann Oncol. 2007 Sep;18(9):1493-9.
Cost-effectiveness of trastuzumab in the adjuvant treatment of early breast cancer: a model-based analysis of the HERA and FinHer trial.

Dedes K, Szucs T, Imesch P, Fedier A, Fehr M, Fink D.
Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich.
BACKGROUND: Routine adjuvant administration of trastuzumab (T) has been implemented in most centers, but its economic impact has not yet been well examined. METHODS: A Markov model was constructed based on clinical data of the Herceptin Adjuvant (HERA) and the Finland Herceptin (FinHer) trials. Costs from the perspective of a Swiss health care provider were calculated based on resource use. RESULTS: On the basis of HERA data, our model yielded an overall survival rate of 71.8% for the T group versus 62.8% for the control group [risk ratio (RR) = 0.87) after 10 years and 62.9% versus 52.7% (RR = 0.84) after 15 years. Cost-effectiveness resulted in 40505 Euros (EUR) per life years gained (LYG) after 10 years and 19673 EUR per LYG after 15 years. For the FinHer regimen, overall survival after 10 and 15 years resulted in 81.8% versus 66.1% (RR = 0.81) and 73.6% versus 57.0% (RR = 0.77). Costs of 8497 EUR per patient could be saved after 10 years and 9256 EUR after 15 years compared with the control group. CONCLUSION: In a long-term perspective, adjuvant T based on the HERA regimen can be considered cost-effective. The regimen used in the FinHer trial is even cost saving, but estimations are based on a single small trial.
PMID: 17761705 [PubMed - in process]

Joe · 09-01-2007, 12:02 PM

Perhaps Michael Moore overlooked this in "Sicko".

Regards
Joe

KellyA · 09-01-2007, 12:06 PM

Forgive me, but I cannot seem to even follow a aentence these days when I am reading :-) Could someone put this into kindergarten terms for me?

Love, Kelly

Christine MH-UK · 09-01-2007, 12:18 PM

I am not thinking so much of FinHer as smaller studies like Hurley's regime HCT->AC, which did extremely well in women with stage III BC, or Buzdar's study where (Taxotere+Herceptin)->(FEC+Herceptin) had no recurrences (although I suspect that the Herceptin should be tried with lapatinib, which is synergistic with FEC at the cell level, one because it just seems like there must be a cardiotoxicity issue mixing it with FEC, an anthracycline, even though there supposedly wasn't one in the small trial).

While I don't think New Zealand has done the right thing in adopting FinHer without treating it as somewhat of a trial, it would be worthwhile to patients to know if short-term herceptin is effective. Herceptin's great, but going to the hospital for a whole year has caused some patients I know to have trouble getting on with their life. I for one found the cancer hospital to be a real downer. I had herceptin insomnia, too. I'm not knocking herceptin, which is a great drug, but a year is very long and I know some very high risk patients who had hardly finished herceptin when they recurred, which doesn't seem fair. Plus, shorter treatments should at the very least mean fewer MUGAS.

Lani · 09-01-2007, 01:37 PM

The accountant-types were "Cruncing the numbers" as to how many years more survival one buys for xxxx dollars worth of herceptin. First they looked at those who got one whole year of herceptin as in the HERA STUDY...then they looked at those who got 3 months of herceptin as in the FinHer study.

GOVERNMENTS AND INSURANCE COMPANIES are trying to rationalize cutting down on what they pay for.

hutchibk · 09-01-2007, 03:40 PM

And I would suggest to be aware of this when we eventually end up in some kind of universal health care. The rationalizing will get worse, not better.

Karen Weixel · 09-01-2007, 09:10 PM

I agree with you Brenda.

Karen

Hopeful · 09-02-2007, 09:50 AM

I think it is important to remember that "more" treatment is not necessarily "better" treatment. My onc asked me if I knew how they decided on one year of adjuvant Herceptin as the optimum tx, and I said no. He said, "Well, they had to pick a number!" I did a little research later, and found that the toxicity trials had determined that a year of Herceptin was "safe," so this is what they based the protocol on. Since Herceptin has been administered in the adjuvant setting, it appears many more women than those in the trials experience some type of cardiac damage, from reduced LVEF to outright heart failure. I think the duration of tx should be tailored to the stage of the disease, rather than all stages 1a through IIIC get the same protocol. The cardiotoxicity of the drug needs to be considered, and, if early stagers can do perfectly well with under 1 year of tx, it makes sense to reduce the duration of tx and the potential for heart damage.

Hopeful

Lani · 09-02-2007, 11:49 AM

is supposed to give the best care they know about and then add something to it or modify it in someway that noone is getting less than the best care they have already determined (whether for fear of lawsuits, problems getting approval of hospital human use committees, etc)

It seems most of these studies will take place in countries where few have access to get one year of therapy and thus, even if they get in the arm with a shorter course of therapy, they are better off than if they had not participated in the clinical trial or in countries where the governments have the final say on whether or not and for how long patients are treated with herceptin.