R J W van Kampen1, B L T Ramaekers1, D J A Lobbezoo2, M de Boer1, M W Dercksen3, F van den Berkmortel4, T J Smilde5, A J van de Wouw6, F P J Peters7, J M G van Riel8, N A J B Peters9, V C G Tjan-Heijnen1, M A Joore10. 1. Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. 2. Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; Máxima Medical Center, Eindhoven, P.O. Box 7777, 5500 MB Eindhoven, The Netherlands. 3. Máxima Medical Center, Eindhoven, P.O. Box 7777, 5500 MB Eindhoven, The Netherlands. 4. Zuyderland Medical Center, Heerlen, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands. 5. Jeroen Bosch Hospital, 's-Hertogenbosch, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands. 6. VieCuri Medical Center, Venlo, P.O. Box 1926, 5900 BX Venlo, The Netherlands. 7. Zuyderland Medical Center, Sittard-Geleen, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands. 8. St Elisabeth Hospital, Tilburg, P.O. Box 90151, 5000 LC Tilburg, The Netherlands. 9. St Jans Hospital, Weert, Vogelsbleek 5, 6001 BE Weert, The Netherlands. 10. Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: m.joore@mumc.nl.
Abstract
INTRODUCTION: The aim of our analysis was to assess the real-world cost-effectiveness of bevacizumab in addition to taxane treatment versus taxane monotherapy for HER2-negative metastatic breast cancer compared with the cost-effectiveness based on the efficacy results from a trial. METHODS: A state transition model was built to estimate costs, life years (LYs) and quality-adjusted life years (QALYs) for both treatments. Two scenarios were examined: a real-world scenario and a trial-based scenario in which transition probabilities were primarily based on a real-world cohort study and the E2100 trial, respectively. In both scenarios, costs and utility parameter estimates were extracted from the real-world cohort study. Moreover, the Dutch health care perspective was adopted. RESULTS: In both the real-world and trial scenarios, bevacizumab-taxane is more expensive (incremental costs of €56,213 and €52,750, respectively) and more effective (incremental QALYs of 0.362 and 0.189, respectively) than taxane monotherapy. In the real-world scenario, bevacizumab-taxane compared to taxane monotherapy led to an incremental cost-effectiveness ratio (ICER) of €155,261 per QALY gained. In the trial scenario, the ICER amounted to €278,711 per QALY gained. CONCLUSION: According to the Dutch informal threshold, bevacizumab in addition to taxane treatment was not considered cost-effective for HER2-negative metastatic breast cancer both in a real-world and in a trial scenario.
INTRODUCTION: The aim of our analysis was to assess the real-world cost-effectiveness of bevacizumab in addition to taxane treatment versus taxane monotherapy for HER2-negative metastatic breast cancer compared with the cost-effectiveness based on the efficacy results from a trial. METHODS: A state transition model was built to estimate costs, life years (LYs) and quality-adjusted life years (QALYs) for both treatments. Two scenarios were examined: a real-world scenario and a trial-based scenario in which transition probabilities were primarily based on a real-world cohort study and the E2100 trial, respectively. In both scenarios, costs and utility parameter estimates were extracted from the real-world cohort study. Moreover, the Dutch health care perspective was adopted. RESULTS: In both the real-world and trial scenarios, bevacizumab-taxane is more expensive (incremental costs of €56,213 and €52,750, respectively) and more effective (incremental QALYs of 0.362 and 0.189, respectively) than taxane monotherapy. In the real-world scenario, bevacizumab-taxane compared to taxane monotherapy led to an incremental cost-effectiveness ratio (ICER) of €155,261 per QALY gained. In the trial scenario, the ICER amounted to €278,711 per QALY gained. CONCLUSION: According to the Dutch informal threshold, bevacizumab in addition to taxane treatment was not considered cost-effective for HER2-negative metastatic breast cancer both in a real-world and in a trial scenario.
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