Pharmacoeconomic evaluation of trastuzumab deruxtecan versus chemotherapy in the second-line treatment of advanced breast cancer with HER-2 low expression
- VernacularTitle:德曲妥珠单抗对比化疗方案二线治疗HER-2低表达晚期乳腺癌的经济学评价
- Author:
Xue LI
1
;
Caifeng JIA
2
;
Ying ZHENG
1
;
Sen ZHANG
1
;
Meiqi WANG
3
;
Mingxia WANG
2
Author Information
1. Dept. of Pharmacy，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
2. Dept. of Clinical Pharmacology，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
3. Breast Center，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China
- Publication Type:Journal Article
- Keywords:
trastuzumab deruxtecan;
advanced breast cancer;
HER-2 low expression;
second-line treatment;
Markov model
- From:
China Pharmacy
2024;35(19):2383-2390
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the economics of trastuzumab deruxtecan versus the physician-selected chemotherapy （TPC） regimen in the second-line treatment of advanced breast cancer with epidermal growth factor receptor 2 （HER-2） low expression from the perspective of the Chinese healthcare system. METHODS Based on the data of DESTINY-Breast04 clinical trial， the dynamic Markov model was constructed. The time frame of the model simulation was 10 years， and the cycle was 3 weeks. Taking cost， quality-adjusted life year （QALY） and incremental cost-effectiveness ratio （ICER） as the model output indicators， the discount rate of 5% was applied， and 3 times China’s per capita gross domestic product （GDP） in 2023 was taken as the willingness-to-pay （WTP） threshold value. Cost-utility analysis was used to evaluate the economics of the two treatment regiments in the hormone receptor-positive cohort and all patient cohorts， and uncertainty analysis was used to verify the robustness of the basic analysis result. RESULTS The results of the basic analysis showed that compared with the TPC regimen， the ICER value of trastuzumab deruxtecan regimen edu.cn were 1 045 655.76 and 906 404.99 yuan/QALY in the hormone receptor-positive cohort and all patients， respectively， both exceeding the WTP threshold （268 074 yuan/QALY）. The results of single factor sensitivity analysis showed that progression-free survival utility value， the price of trastuzumab deruxtecan and progression disease utility had a significant influence on the model results. The results of probability sensitivity analysis showed that when the WTP threshold was 3 times China’s per capita GDP in 2023， the probability of economic viability of trastuzumab deruxtecan was 0. The results of scenario analysis showed that when the patient assistance program for trastuzumab deruxtecan was considered， the probability of trastuzumab deruxtecan regimen being economical was 0. However， when the price of trastuzumab deruxtecan was reduced by 70%， the probability of its being cost-effective was significantly increased to 82.80%. CONCLUSIONS At a WTP threshold of 3 times China’s per capita GDP in 2023， the trastuzumab deruxtecan regimen is not cost-effective compared to TPC regimen for the second-line treatment of advanced breast cancer with HER-2 low expression. Reducing the price of trastuzumab deruxtecan by region can improve its cost-effectiveness.
