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The value of second-line anti-HER2 therapy in metastatic HER-2 positive patients: a cost-effectiveness analysis in
Lu Li1, Shilei Yang1, Fengqi Fang2
1Department of Pharmacy, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Background:
Breast cancer (BC) is one of the most common cancers worldwide. The inevitability of drug resistance to initial anti-HER-2 therapy necessitates the emergence of second-line anti-HER-2 drugs which exhibit a promising outlook. Consequently, it is imperative to appraise their efficacy through network meta-analysis and ascertain their comparative cost-effectiveness.
Methods:
The data used in our analysis were acquired from patients enrolled in the EMILIA, DESTINY-Breast03, and PHOEBE phase III randomized clinical trials. A partitioned survival model was used for patients diagnosed with HER-2-positive metastatic Breast cancer. The model was crafted with a time horizon of 10 years, operating on a 21-day cycle and incorporating a 5% discount rate for both costs and outcomes. The willingness-to-pay threshold was set at $36,058.06 per quality-adjusted life year (QALY). The impact of parameter uncertainty on the findings was assessed using a one-way deterministic sensitivity analysis and probability sensitivity analysis.
Findings:
Within the model encompassing 1782 patients, the utilization of pyrotinib plus capecitabine (PC) treatment yielded an additional 0.70 QALY in comparison to T-DM1, resulting in an incremental cost-effectiveness ratio (ICER) of $31,121.53 per QALY gained. Similarly, the administration of T-DXd treatment led to an additional 0.80 QALY compared to T-DM1, resulting in an ICER of $153,950.19 per QALY gained. The PC strategies are considered more cost-effective than T-DXd when the WTP threshold is set at $36,058.06 per QALY. However, this method is not cost effective for T-DXd. The probability of the PC strategies being cost-effective was 62%, whereas the probability of T-DXd was 0% when compared to T-DM1.
Conclusion:
PC is a cost-effective therapy for patients afflicted with HER-2-positive metastatic BC compared to T-DM1 from the perspective of China at a WTP threshold of $36,058.06 per QALY. Nevertheless, T-DXd is not as cost-effective as T-DM1, considering its current medication pricing. Therefore, reducing the cost of T-DXd could improve its overall cost-effectiveness.
Insights
Pyrotinib plus capecitabine (PC) is a cost-effective second-line treatment for HER-2-positive metastatic breast cancer compared to T-DM1. Trastuzumab deruxtecan (T-DXd) is not cost-effective at current pricing, suggesting a need for price reduction.
Area of Science:
- Oncology
- Pharmacoeconomics
- Health Technology Assessment
Background:
- Breast cancer (BC) is a leading global cancer, with drug resistance to first-line anti-HER2 therapy necessitating effective second-line treatments.
- Evaluating the comparative efficacy and cost-effectiveness of emerging second-line anti-HER2 drugs is crucial for clinical decision-making.
Purpose of the Study:
- To conduct a network meta-analysis and cost-effectiveness evaluation of second-line therapies for HER-2-positive metastatic breast cancer.
- To compare pyrotinib plus capecitabine (PC) and trastuzumab deruxtecan (T-DXd) against T-DM1.
Main Methods:
- Utilized data from phase III randomized clinical trials (EMILIA, DESTINY-Breast03, PHOEBE).
- Employed a partitioned survival model over a 10-year horizon with a 21-day cycle, incorporating a 5% discount rate.
- Assessed cost-effectiveness using a willingness-to-pay threshold of $36,058.06 per QALY, with sensitivity analyses performed.
Main Results:
- PC demonstrated an additional 0.70 QALY gain versus T-DM1 with an ICER of $31,121.53/QALY.
- T-DXd showed an additional 0.80 QALY gain versus T-DM1 with an ICER of $153,950.19/QALY.
- PC was found to be more cost-effective than T-DXd at the specified WTP threshold, with a 62% probability of cost-effectiveness compared to 0% for T-DXd versus T-DM1.
Conclusions:
- Pyrotinib plus capecitabine (PC) is a cost-effective second-line therapy for HER-2-positive metastatic breast cancer in China.
- Trastuzumab deruxtecan (T-DXd) is not currently cost-effective compared to T-DM1, primarily due to its pricing.
- Reducing the cost of T-DXd could significantly enhance its cost-effectiveness profile.
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