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Human epidermal growth factor receptor 2 expression in early breast cancer patients: a Swiss cost–effectiveness analysis of different predictive assay strategies

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Abstract

Trastuzumab has conferred significant clinical benefits in HER-2-positive breast carcinomas. HER-2 status is determined by immunohistochemistry (IHC) and/or fluorescence in situ hybridisation (FISH), but appropriate assessment of HER2 status remains subject to considerable debate. Data on the health economic impact of HER-2 test strategies are limited. A life-long Markov state transition model was used to assess costs and effectiveness of HER-2 assay strategies (based on IHC, FISH, both combined or FISH confirmation of IHC2+) for a hypothetical cohort of early breast cancer patients from the perspective of the Swiss health system. We compared clinically relevant strategies of predictive testing and subsequent trastuzumab treatment of HER-2-positive patients only. FISH testing was the most cost–effective strategy with an incremental cost–effectiveness ratio of €12,245 per additional quality-adjusted life-year (QALY) gained, compared to no trastuzumab treatment. The next best strategy was parallel IHC and FISH, with costs of €400,154/QALY gained compared to FISH alone. FISH as primary HER-2 testing modality remained the preferred option in deterministic and probabilistic sensitivity analysis. Predictive testing to identify adjuvant breast cancer patients who benefit from trastuzumab treatment is a clinical and economic necessity. Our model identifies FISH as the most cost–effective approach.

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Acknowledgement

We thank KJ Dedes, Department of Obstetrics and Gynaecology and BC Pestalozzi, Department of Oncology, University Hospital Zurich, Switzerland for commenting on clinical issues.

Conflict of interest

No conflict of interest to declare.

Funding

This work was supported by an unrestricted educational grant of the ETH Zurich Foundation and the Competence Center for Systems Physiology and Metabolic Diseases (CC-SPMD), Zurich, Switzerland.

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Authors and Affiliations

  1. Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland

    Patricia R. Blank & Matthias Schwenkglenks

  2. Competence Center for Systems Physiology and Metabolic Diseases (CC-SPMD), Zurich, Switzerland

    Patricia R. Blank & Holger Moch

  3. European Center of Pharmaceutical Medicine, University of Basel, Klingelberstrasse 61, 4056, Basel, Switzerland

    Matthias Schwenkglenks & Thomas D. Szucs

  4. Department of Pathology, Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland

    Holger Moch

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  1. Patricia R. Blank
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Correspondence to Patricia R. Blank.

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Blank, P.R., Schwenkglenks, M., Moch, H. et al. Human epidermal growth factor receptor 2 expression in early breast cancer patients: a Swiss cost–effectiveness analysis of different predictive assay strategies. Breast Cancer Res Treat 124, 497–507 (2010). https://doi.org/10.1007/s10549-010-0862-7

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