Cost-effectiveness analysis of 1 st through 3 rd line sequential targeted therapy in HER 2-positive metastatic breast cancer in the United States

Purpose Based on available phase III trial data, we performed a cost-effectiveness analysis of different treatment strategies that can be used in patients with newly diagnosed HER2-positive metastatic breast cancer (mBC). Patients and methods We constructed a Markov model to assess the cost-effectiveness of four different HER2 targeted treatment sequences in patients with HER2-positive mBC treated in the U.S. The model followed patients weekly over their remaining life expectancies. Health states considered were progression-free survival (PFS) 1st to 3rd lines, and death. Transitional probabilities were based on published phase III trials. Cost data (2015 US dollars) were captured from the U.S. Centers for Medicare and Medicaid Services (CMS) drug payment table and physician fee schedule. Health utility data were extracted from published studies. The outcomes considered were PFS, OS, costs, QALYs, the incremental cost per QALY gained ratio, and the net monetary benefit. Deterministic and probabilistic sensitivity analyses assessed the uncertainty around key model parameters and their joint impact on the base-case results. Results The combination of trastuzumab, pertuzumab, and docetaxel (THP) as first-line therapy, trastuzumab emtansine (T-DM1) as second-line therapy, and lapatinib/capecitabine third-line resulted in 1.81 QALYs, at a cost of $335,231.35. The combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab yielded 1.41 QALYs, at a cost of $175,240.69. The least clinically This manuscript was presented at the 21st annual international meeting of the International Society for Pharmacoeconomics and Outcomes Research in Washington D.C. (Poster Presentations Session III Tuesday, May 24, 2016). Georges Adunlin and Askal A. Ali have contributed equally to this work. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-3978-6) contains supplementary material, which is available to authorized users. & Vakaramoko Diaby diaby_v@yahoo.fr; vakaramoko.diaby@famu.edu Georges Adunlin gadunlin@vcu.edu Askal A. Ali askal1.ali@famu.edu Simon B. Zeichner szeichn@emory.edu Gilberto de Lima Lopes glopes.md@gmail.com Christine G. Kohn christine.kohn@hhchealth.org Alberto J. Montero MONTERO2@ccf.org 1 Economic, Social & Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, 200 Dyson Pharmacy Bldg. , 1520 Martin Luther King Jr. Blvd., Tallahassee, FL 32307, USA 2 Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, PO Box 980149, Richmond, VA 23298, USA 3 Winship Cancer Institute at Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA 4 Oncoclinicas Group, Avenida Faria Lima 4300, 15 andar, São Paulo, SP, Brazil 5 Health Economics and Outcomes Research, University of Saint Joseph School of Pharmacy, UConn/Hartford Hospital Evidence-based Practice Center, 229 Trumbull Street, Hartford, CT 06103, USA 123 Breast Cancer Res Treat DOI 10.1007/s10549-016-3978-6