Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2-metastatic breast cancer
10.6039/j.issn.1001-0408.2025.15.13
- 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
;
Yuxi ZHANG
;
Shengnan GAO
;
Ning GAO
;
Bing FENG
;
Ran LIU
;
Qian LI
Author Information
1. 河北医科大学第三医院临床药学部,石家庄 050051
- Publication Type:Journal Article
- Keywords:
capecitabine;
metronomic chemotherapy;
aromatase inhibitors;
HR+/HER2-metastatic breast cancer;
partitioned survival model;
cost-utility analysis
- 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 stable phase.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.
