Abstract
Background: The clinical evaluation of HER2CLIMB trial showed a 21. 9-month median overall survival with the triplet regimens of tucatinib, capecitabine, and trastuzumab (TXT) for patients with human epidermal growth factor receptor 2 (HER2) –overexpressing metastatic breast cancer. From the payer's perspective of the United States and China, a cost-effectiveness analysis was conducted to evaluate the costs and benefits of adding tucatinib in this study.Methods: We constructed a Markov model for the economic evaluation of adding tucatinib to trastuzumab plus capecitabine in patients with HER-2 positive metastatic breast cancer in the United States and China. The model was conducted with a 10-year time horizon, and the health status was divided into three states: progression-free survival, progressing disease, and death. The health utility scores were consistent with published literature with similar patient status. The transition probabilities were derived from the survival data of the HER2CLIMB study. The unit prices of medicines were obtained from the West China Hospital, Red Book, and published literature. Outcomes were measured in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio, which robustness was evaluated by deterministic and probabilistic sensitivity analyses.Results: Compared with the two-drug regimen of trastuzumab plus capecitabine (TX), the addition of tucatinib increased 0.21 QALY, with an increasing cost of $146,995.05 and $19,022.97 in the United States and China, respectively. The incremental cost-effectiveness ratios (ICERs) for the TXT versus TX was $699,976.43 in the U.S. and $90,585.57 in China, both of which are higher than their respective threshold of willingness to play. Deterministic sensitivity analysis shows that the price of tucatinib is the parameter that has the most significant impact on ICERs, but it does not change the results of the model. Probability sensitivity analysis shows that the probability of cost-effective for TXT is 0 in the base case.Conclusion: In the United States and China, tucatinib combined with trastuzumab and capecitabine is not cost-effective for patients with HER-2 positive metastatic breast cancer.
Highlights
Cancer statistics in 2020 show that the incidence of breast cancer ranks first among female tumors (276,480 cases) and the secondhighest mortality rate (42,170 death) in the United States [1]
The incremental costeffectiveness ratios (ICERs) for the TXT versus TX was $699,976.43 in the U.S and $90,585.57 in China, both of which are higher than their respective threshold of willingness to play
Deterministic sensitivity analysis shows that the price of tucatinib is the parameter that has the most significant impact on ICERs, but it does not change the results of the model
Summary
Cancer statistics in 2020 show that the incidence of breast cancer ranks first among female tumors (276,480 cases) and the secondhighest mortality rate (42,170 death) in the United States [1]. In China, breast cancer is the most common cancer among women, with 268.6 thousand people diagnosed with breast cancer in 2015 [2] These cases in China account for 17.6% of all newly diagnosed breast cancers and 11.1% of all breast cancer deaths worldwide [2, 3]. An estimated 5.7% of incidence cases of breast cancer cases are distributed in Stage IV or metastatic in the United States [4]. In China, up to 21.4% of patients with breast cancer have distant metastases at the initial diagnosis [5]. From the payer’s perspective of the United States and China, a cost-effectiveness analysis was conducted to evaluate the costs and benefits of adding tucatinib in this study
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