Cost-effectiveness of pertuzumab and trastuzumab as a first-line treatment of HER2-positive metastatic breast cancer in China

Wang, Hao; Wang, Ye; Gong, Ruixue; Geng, Yan; Li, Li

doi:10.21037/apm-21-2412

Cited by 12 publications

(14 citation statements)

References 26 publications

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“…In an incurable setting, an improved PFS means more time spent accruing costs for expensive therapies. It explained that even after a 100% price reduction at the conventional threshold, the pertuzumab regimen was still unlikely to provide reasonable economic value and likely to produce an additional healthcare burden [ 20 , 43 ]. It further confirmed the necessity of investigating second-line therapeutic drugs.…”

Section: Discussionmentioning

confidence: 99%

“…To incorporate valuable new drugs into the Basic Medical Insurance Drug List and to improve the accessibility of drugs in a timely manner, the Chinese government adjusted Medicare Drug Lists through price negotiations with the drug manufacturer. After the national medical insurance price negotiation in 2018, 97 innovative drugs were included in the Type B category of the National Drugs Catalogue of Basic Medical Insurance, Industrial Injury Insurance and Reproductive Insurance (2019 edition), which included pyrotinib, with drug prices cut by an average of 60.7% [ 20 ]. Pyrotinib is a second-generation irreversible pan-HER tyrosine kinase inhibitor that potently targets EGFR, HER2, and HER4 [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage

Bao

Zhang

et al. 2022

Current Oncology

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Background: The overexpression of the human epidermal growth factor receptor-2 (HER2) gene is present in 20~25% of breast cancer (BC) patients, contributing to an inferior prognosis. Recent clinical trials showed that pyrotinib has promising antitumor activities and acceptable tolerability for those patients (ClinicalTrials.gov, NCT03080805 and NCT02422199). Therefore, this study aims to assess the cost-effectiveness of pyrotinib plus capecitabine versus lapatinib plus capecitabine for patients with HER2-positive metastatic BC after prior trastuzumab. Methods: A lifetime-partitioned survival model was established to evaluate health and economic outcomes with different treatment strategies. The primary outcome was the incremental cost-effectiveness ratio (ICER). Data were derived from the published literature, clinical trials, expert opinions, and other local charges. Sensitivity analyses were performed to assess the robustness of the findings. Scenario analyses were developed to make further evaluations. Results: The pyrotinib regimen had significant advantages over the lapatinib regimen after enrolling in the National Reimbursement Drug List (NRDL), with cost savings of USD 15,599.27 and a gain of 0.53 QALYs. Meanwhile, before enrolling in NRDL, the pyrotinib regimen afforded the same QALYs at a higher incremental cost of USD 45,400.64 versus the lapatinib regimen, producing an ICER of USD 85,944.79 per QALY. Scenario analyses yielded similar results. Sensitivity analyses suggested stability in the cost-effectiveness findings. Conclusions: Compared to lapatinib plus capecitabine, the pyrotinib plus capecitabine enrolled in NRDL is a cost-effective alternative second-line treatment for patients with HER2-positive metastatic BC in China.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage

Bao

Zhang

et al. 2022

Current Oncology

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“…Costs related to subsequent BSC were derived from published literatures (17). The dosages of chemotherapy agents and T-Dxd were calculated based on standard human body surface area of 1.72 m 2 and a standard female bodyweight of 55 kg, respectively (18). Although T-Dxd is yet to be approved for Chinese market, it became available in Hainan's Boao Lecheng International Medical Tourism Pilot Zone in February 2022.…”

Section: Cost Estimatesmentioning

confidence: 99%

“…Only the costs related to managing grade 3 or higher AEs were included for this study; grade 1-2 AEs were considered manageable within standard patient monitoring. The costs of managing grade 3-5 AEs were derived from previously published economic studies (18)(19)(20)(21)(22)(23). Detailed information was shown in Table 3.…”

Section: Cost Estimatesmentioning

confidence: 99%

Cost-effectiveness analysis of trastuzumab deruxtecan in patients with HER2-low advanced breast cancer based on DESTINY-Breast04

Zhan

Huang

et al. 2023

Front. Public Health

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Background and purposeBreast cancer is a rapidly raising healthcare problem worldwide. DESTINY-Breast04 demonstrated that trastuzumab deruxtecan (T-Dxd) had a survival advantage comparing to the physician's choice of chemotherapy for patients with HER2-low metastatic breast cancer. But at the same time, this expensive novel treatment also brought an economic burden. This study assessed the cost-effectiveness of T-Dxd based on results of DESTINY-Breast04 from the perspective of Chinese healthcare system.Materials and methodsA three-state partitioned-survival model [progression-free survival (PFS), progressive disease (PD) and death] based on data from DESTINY-Breast04 and Chinese healthcare system was used to estimate the incremental cost-effectiveness ratio (ICER) of T-Dxd vs. the physician's choice of chemotherapy for HER2-low metastatic breast cancer. Costs, quality-adjusted life-years (QALYs) and the ICER in terms of 2022 US$ per QALY gained were calculated for both hormone receptor–positive cohort and all patients. One-way and probabilistic sensitivity analyses were performed to assess the model robustness.ResultsCompared with the physician's choice of chemotherapy, T-Dxd increased costs by $104,168.30, while gaining 0.31 QALYs, resulting in an ICER of $336,026.77 per QALY in all patients. The costs of T-Dxd and the utility of PFS were the crucial factors in determining the ICER. In the hormone receptor–positive cohort, the ICER was lower than that in all patients, with the ICER of $274,905.72 per QALY. The ICER was much higher than the commonly accepted willingness-to-pay threshold ($357,96.83 per QALY).ConclusionT-Dxd as second- or subsequent-line treatment is not a cost-effective treatment option for HER2-low metastatic breast cancer from the perspective of the Chinese healthcare system.

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“…The number of disability-adjusted life years caused by renal cancer in China is as high as 643,000 years, accounting for 0.17% of the total disability-adjusted life years ( 5 ). This disease poses a severe economic burden and public health problem, especially for countries with limited health resources ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of first-line nivolumab plus cabozantinib for advanced renal cell carcinoma in China

Wang

et al. 2022

Front. Public Health

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BackgroundIn the Checkmate9ER trial, first-line treatment with nivolumab combined with cabozantinib (NI + CA) has shown efficacy for advanced renal cell carcinoma. This study aims to evaluate the impact of the health and economic outcomes of NI + CA in China.MethodsClinical efficacy data were derived from pivotal phase III CheckMate 9ER trial. A three-state partitioned survival model was established based on disease progression. Progression-free survival and overall survival of NI + CA vs. sunitinib were fitted with log-logistic and log-normal distributions, respectively. Mixture cure, non-mixture cure, and Royston/Parmar spline models were used to evaluate model robustness. The results derived the computational cost from the Chinese healthcare system perspective. The primary outcomes were quality-adjusted life-years (QALYs), total cost in US dollars, as well as incremental cost-effectiveness ratios (ICERs) at the willingness-to-pay threshold in China. One-way and probabilistic sensitivity analysis were also used to assess the robustness of the model.ResultsIn the base-case analysis result, 0.86 additional QALYs could be obtained in the NI+CA (3.84 QALYs) versus the sunitinib strategy (2.97 QALYs). The ICER of NI+CA compared with the sunitinib strategy was US$292,945 per QALY. The ICER value in the NI+CA strategy was higher than the Chinese willingness-to-pay threshold of US$38,024 per QALY. Although NI+CA can improve long-term patient survival significantly over sunitinib in the treatment of advanced renal cell carcinoma, it is unlikely to be cost-effective due to high cost. The results of the one-way sensitivity analysis showed that drug cost, health utility value at the stage of disease progression, and subsequent treatment proportion had a greater impact on the stability of ICER values.ConclusionsNivolumab combined with cabozantinib can prolong the life of patients with advanced renal cell carcinoma and improve their quality of life, but there is a corresponding increase in medical cost. The NI + CA strategy is unlikely to be considered cost-effective in the treatment of advanced RCC from the perspective of Chinese healthcare system.

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Cost-effectiveness of pertuzumab and trastuzumab as a first-line treatment of HER2-positive metastatic breast cancer in China

Cited by 12 publications

References 26 publications

Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage

Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage

Cost-effectiveness analysis of trastuzumab deruxtecan in patients with HER2-low advanced breast cancer based on DESTINY-Breast04

Economic evaluation of first-line nivolumab plus cabozantinib for advanced renal cell carcinoma in China

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