Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer
- VernacularTitle:卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析
- Author:
Ranran ZHANG
1
;
Guoqiang LIU
1
;
Yuxi ZHANG
1
;
Shengnan GAO
2
;
Ning GAO
1
;
Bing FENG
1
;
Ran LIU
1
;
Qian LI
1
Author Information
1. Dept. of Clinical Pharmacy，Hebei Medical University Third Hospital，Shijiazhuang 050051，China
2. Hebei Society for Integrated Drug and Health Technology Assessment，Shijiazhuang 050051，China
- Publication Type:Journal Article
- Keywords:
capecitabine;
metronomic chemotherapy;
aromatase inhibitors;
HR+/HER2－ metastatic breast cancer;
partitioned
- From:
China Pharmacy
2025;36(15):1893-1898
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor （AI） versus AI monotherapy as first-line treatment for hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） metastatic breast cancer， thereby providing evidence-based support for clinical therapeutic decision- making and healthcare policy formulation. METHODS Based on the MECCA trial， a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients’ lifetime. The model outputs included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analyses were performed to validate the robustness of base-case results， while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year， 20-year， and lifetime time horizons. RESULTS With the willingness-to-pay （WTP） threshold set at 1 times China’s 2024 per capita gross domestic product （GDP） （95 749 yuan/QALY）， patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility （0.66 QALYs） while incurring higher costs， with ICER of 27 684.85 yuan/QALY. Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate， drug costs of the capecitabine metronomic chemotherapy combined with AI group， utility value in the progression-free survival state， follow-up costs， and treatment costs in the subsequent stablephase. Probabilistic sensitivity analysis indicated that when the WTP threshold ≥49 250 yuan/QALY， the capecitabine metronomic chemotherapy combined with AI regimen had a 100% probability of being cost-effective. Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year， 20-year， and lifetime study horizons. CONCLUSIONS Under the premise that the WTP threshold is set at 1 times China’s per capita GDP in 2024， capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2－ metastatic breast cancer.
