Cost‐effectiveness analysis of trastuzumab emtansine (T‐DM1) in treating HER‐2 positive advanced breast cancer in Taiwan

Wang, Lin Chien; Kuo, Chun Nan; Ko, Yu

doi:10.1111/tbj.14053

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…We conducted an economic analysis to compare the T-DM1 with four alternative regimens as second-line Our results were consistent with the previously published reports [22,27,28]. The recent study of Wang et al [27] The present study has some limitations that deserve to be mentioned. First, due to the lack of randomized controlled trials, HR from indirect comparison was used to calculate the transition probabilities.…”

Section: Discussionsupporting

confidence: 89%

Cost-effectiveness Analysis of Trastuzumab Emtansine as Second-line Therapy for HER2-Positive Breast Cancer in China

Zhang

Huang

2021

Clin Drug Investig

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Section: Discussionsupporting

confidence: 89%

Cost-effectiveness Analysis of Trastuzumab Emtansine as Second-line Therapy for HER2-Positive Breast Cancer in China

Zhang

Huang

2021

Clin Drug Investig

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“…Our results were consistent with the previously published reports [22,27,28]. The recent study of Wang et al [27] conducted a lifetime horizon Markov model to evaluate the cost-effectiveness of T-DM1 treatment with metastatic breast cancer in Taiwan. They found that the estimated ICERs of T-DM1 versus Cap + Lap was New Taiwan dollars (NTDs) 5,704,717/QALY gained.…”

Section: Discussionsupporting

confidence: 92%

Cost-Effectiveness Analysis of Trastuzumab Emtansine as Second-Line Therapy for HER2 Positive Breast Cancer in China

Zhang

Huang

et al. 2020

Preprint

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ObjectiveTo evaluate the cost-effectiveness of trastuzumab emtansine (T-DM1) as the second-line treatment for patients with human epidermal growth factor receptor-2 (HER2) positive breast cancer from the Chinese healthcare perspective. Capecitabine (Cap), capecitabine + lapatinib (Cap+Lap), capecitabine + trastuzumab (Cap+Tra), capecitabine + trastuzumab + pertuzumab (Cap+Tra+Pre) were selected as comparators.MethodsA three-state Markov simulation model was performed. The state transition probabilities were estimated based on the results of a published network meta-analysis, and utilities were derived from the published literature. The costs populated in the model were acquired from the local charge or previously published studies. Univariate sensitive analysis and probabilistic sensitivity analyses were performed to test the robustness of the results.ResultsTreatment with T-DM1 was estimated to increase the cost by $109,683.7, $106,003.7, $94,212.2, and $63,214.9, and yield a gain of 0.544 quality-adjusted life years (QALYs), 0.383 QALYs, 0.367 QALYs, 0.087 QALYs in comparison with Cap, Cap+Lap, Cap+Tra, and Cap+Tra+Pre, respectively. Corresponding incremental cost-effectiveness ratios (ICERs) were $201,624.4, $276,772.1, $256,709.0, and $726,608.0 per QALY. The probabilities of T-DM1 as the dominant option were 0% at the WTP threshold of $30,829.3/QALY.ConclusionsT-DM1, as second-line therapy in the treatment of HER2 positive breast cancer, is not a cost-effective option in China. Given the significant clinical efficacy, an appropriate price reduction of T-DM1 is required to benefit more HER2 positive breast cancer patients.

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“…The results of PSA showed that T-DM1 was not cost-effective for treating HER2-positive advanced BC. Similar results with ADCs being not cost-effective were obtain in several study (Le et al, 2016;Diaby et al, 2017;Wang et al, 2020;Zhang et al, 2021). However, Guiliani et al reported that T-DM1 was a cost-effective option for pretreated HER2-positive BC with an ICER of € 406 per month of OS gained (Giuliani and Bonetti, 2021).…”

Section: Discussionsupporting

confidence: 75%

Cost-effectiveness analysis of trastuzumab deruxtecan versus trastuzumab emtansine for HER2-positive breast cancer

et al. 2022

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Background: The DESTINY-Breast03 clinical trial demonstrated that trastuzumab deruxtecan (T-DXd) outperformed trastuzumab emtansine (T-DM1) in progression-free survival (PFS) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC). Considering the excessive cost of antibody-drug conjugates, the clinical value of T-DXd must be assessed by both its efficacy and cost. We compared the cost-effectiveness of T-DXd and T-DM1 for patients with HER2-positive mBC pretreated with anti-HER2 antibodies and a taxane from the perspectives of the United States (US) and China.Methods: A comprehensive Markov model based on the DESTINY-Breast03 phase III randomized clinical trial was used to compared the cost and effectiveness of T-DXd and T-DM1 for HER2-positive mBC. Data on direct medical cost and utilities were collected from published literatures. The recorded data included the costs, quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER) and incremental net-health benefit (INHB). Sensitivity analysis was conducted to measure the potential uncertainty due to parameter variability. Additional subgroup cost-effectiveness analysis was performed.Results: Treatment of HER2-positive mBC with T-DXd gained 0.73 QALYs compared with T-DM1 strategy. The incremental cost was $59,942 in the US, with an ICER of $ 82,112/QALY and an INHB of 0.33 QALYs, respectively. In China, the incremental cost of T-DXd versus T-DM1 was $222,680, with an ICER of $305,041/QALY and a negative INHB of -5.18 QALYs. At willingness-to-pay (WTP) threshold of $150,000/QALY in the US and $37,653/QALY in China, the probability of T-DXd as the dominant option was 77.5 and 0.1%, respectively. The unit price of T-DXd greatly influenced the results according to one-way sensitivity analysis. To meet the 50% or 90% chance of being cost-effective, the estimated cost of T-DXd would need to be less than $17.24/mg and $12.06/mg in China, respectively.Conclusion: T-DXd is more cost-effective than T-DM1 for patients with HER2-positive mBC in the US, but not in China at current drug prices.

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Cost‐effectiveness analysis of trastuzumab emtansine (T‐DM1) in treating HER‐2 positive advanced breast cancer in Taiwan

Cited by 5 publications

References 3 publications

Cost-effectiveness Analysis of Trastuzumab Emtansine as Second-line Therapy for HER2-Positive Breast Cancer in China

Cost-effectiveness Analysis of Trastuzumab Emtansine as Second-line Therapy for HER2-Positive Breast Cancer in China

Cost-Effectiveness Analysis of Trastuzumab Emtansine as Second-Line Therapy for HER2 Positive Breast Cancer in China

Cost-effectiveness analysis of trastuzumab deruxtecan versus trastuzumab emtansine for HER2-positive breast cancer

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