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A cost-effectiveness analysis of trastuzumab-containing treatment sequences for HER-2 positive metastatic breast cancer patients in Taiwan
- Source :
- The Breast : official journal of the European Society of Mastology, Breast, Vol 49, Iss, Pp 141-148 (2020)
- Publication Year :
- 2019
- Publisher :
- Elsevier, 2019.
-
Abstract
- Objective Treatment options for HER-2-positive metastatic breast cancer (mBC) patients have expanded markedly since trastuzumab approval in 1998. Several other regimens are now available, including pertuzumab plus trastuzumab plus docetaxel, T-DM1, capecitabine plus lapatinib, and trastuzumab plus lapatinib. This study assesses the cost-effectiveness of four treatment sequences for HER-2-positive mBC according to the Taiwanese National Health Insurance Administration (TNHIA). Methods Costs (U.S. Dollars) and effectiveness (quality-adjusted life years) of four treatment sequences for HER-2-positive mBC patients were examined using a Markov model over a lifetime horizon. Transition probabilities, disease progression, and probability of adverse events and survival were derived from clinical trial data. Costs and health utilities were estimated from TNHIA, Taipei Medical University Hospital, and the literature. Deterministic, probabilistic sensitivity analyses and a scenario analysis examined parameter uncertainty and accounted for drug wastage in dosage and cost calculations. Results Sequence 3 (1st line: trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: trastuzumab plus lapatinib) was the most cost-effective sequence followed by sequence 1 (1st line: pertuzumab plus trastuzumab plus docetaxel; 2nd line: T-DM1; 3rd line: capecitabine plus lapatinib), and sequence 4 (1st line: trastuzumab plus docetaxel; 2nd line: trastuzumab plus lapatinib; 3rd line: trastuzumab plus capecitabine), respectively. The model was sensitive to costs and transition probabilities, but not particularly sensitive to the wastage assumption. Conclusions From the perspective of the TNHIA, trastuzumab plus docetaxel as 1st line followed by T-DM1 and trastuzumab plus lapatinib as 2nd and 3rd line represents the most cost-effective strategy among the four sequences considered for treating HER-2-positive mBC patients.<br />Highlights • In health systems in which resources are scarce, treatment selection should be carefully considered to preserve efficiency. • We conducted a CEA of four treatment sequences for HER-2-positive mBC in Taiwan, accounting for intravenous drug wastage. • Results of such analyses can be useful to policymakers as they decide on coverage of expensive new anticancer treatments.
- Subjects :
- Oncology
Adult
medicine.medical_specialty
Receptor, ErbB-2
Neoplasm metastasis
Cost-Benefit Analysis
Taiwan
Breast Neoplasms
Docetaxel
Lapatinib
Ado-Trastuzumab Emtansine
Antibodies, Monoclonal, Humanized
lcsh:RC254-282
Capecitabine
03 medical and health sciences
0302 clinical medicine
Breast cancer
Trastuzumab
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
030212 general & internal medicine
skin and connective tissue diseases
neoplasms
Markov chains
business.industry
Cost-effectiveness analysis
General Medicine
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
Metastatic breast cancer
Clinical trial
030220 oncology & carcinogenesis
Surgery
Original Article
Female
Pertuzumab
Quality-Adjusted Life Years
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 15323080 and 09609776
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- The Breast : official journal of the European Society of Mastology
- Accession number :
- edsair.doi.dedup.....b16e67b3ad88fa391114ac045b173ea2