Vakaramoko Diaby1, Hussain Alqhtani2, Sascha van Boemmel-Wegmann3, Ching-Yu Wang4, Askal Ayalew Ali5, Rajesh Balkrishnan6, Yu Ko7, Sofia Palacio8, Gilberto de Lima Lopes9. 1. Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 3317, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA. Electronic address: v.diaby@cop.ufl.edu. 2. Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 2309, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA. Electronic address: hussain.alqhtani@ufl.edu. 3. Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 2309, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA. Electronic address: wegmann@ufl.edu. 4. Department of Pharmaceutical Outcomes and Policy College of Pharmacy, HPNP 2309, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA. Electronic address: chingyuwang@ufl.edu. 5. Economic, Social & Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 200 Dyson Pharmacy Bldg. 1520 Martin Luther King Jr. Blvd, Tallahassee, FL, 32307, USA. Electronic address: askal.ali@famu.edu. 6. Cancer Population Health Core, UVA Cancer Center, Section on Population Health and Prevention Research, University of Virginia School of Medicine, University of Virginia School of Nursing, P.O. Box 800717, Charlottesville, VA, 22908, USA. Electronic address: rb9ap@virginia.edu. 7. School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 11031, Taiwan. Electronic address: nancyko@tmu.edu.tw. 8. Department of Medicine, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, 1120 NW 14th Street, Suite 610N, Miami, FL, USA. Electronic address: sofia.palacio@jhsmiami.org. 9. Sylvester Comprehensive Cancer Center at the University of Miami and the Miller School of Medicine, USA. Electronic address: Glopes@med.miami.edu.
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.
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.