Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States.
Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States.
复制标题
美国 HER2 阳性转移性乳腺癌一至三线序贯靶向治疗的成本效益分析。
DOI：
10.1007/s10549-016-3978-6
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发表时间：
2016-11
影响因子：
3.8
通讯作者：
Montero AJ
中科院分区：
文献类型：
--
作者：
Diaby V;Adunlin G;Ali AA;Zeichner SB;de Lima Lopes G;Kohn CG;Montero AJ
基于现有的III期试验数据，我们对可用于新诊断的HER 2阳性转移性乳腺癌（mBC）患者的不同治疗策略进行了成本效益分析。我们构建了一个马尔可夫模型，以评估四种不同的HER 2靶向治疗序列在美国接受治疗的HER 2阳性mBC患者中的成本效益。该模型每周随访患者剩余的预期寿命。考虑的健康状态为1 - 3线无进展生存期（PFS）和死亡。过渡概率基于已发表的III期试验。成本数据（2015年美元）来自美国医疗保险和医疗补助服务中心（CMS）药物支付表和医生费用表。健康效用数据摘自已发表的研究。所考虑的结局为PFS、OS、成本、QALY、每QALY增量成本比率和净货币收益。确定性和概率敏感性分析评估了关键模型参数的不确定性及其对基本情况结果的联合影响。曲妥珠单抗、帕妥珠单抗和多西他赛（THP）作为一线治疗，曲妥珠单抗-美坦新偶联物（T-DM 1）作为二线治疗，拉帕替尼/卡培他滨三线治疗导致1.81个QDs，成本为335，231.35美元。曲妥珠单抗/多西他赛联合治疗作为一线治疗，不使用后续T-DM 1或帕妥珠单抗，获得1.41个QQD，成本为175，240.69美元。临床有效性最低的序列（1.27 Qs），但最具成本效益的总成本为149，250.19美元，是曲妥珠单抗/多西他赛作为一线治疗，T-DM 1作为二线治疗，曲妥珠单抗/拉帕替尼作为三线治疗。我们的研究结果表明，THP作为一线治疗，其次是T-DM 1作为二线治疗，将需要至少减少50%的总药物采购成本，它被认为是一个具有成本效益的策略。
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). 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) was 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. 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 effective sequence (1.27 QALYs), but most cost-effective at a total cost of $149,250.19, was trastuzumab/docetaxel as first-line therapy, T-DM1 as second-line therapy, and trastuzumab/lapatinib as third line therapy. Our results suggest that THP as first-line therapy, followed by T-DM1 as second-line therapy, would require at least a 50% reduction in the total drug acquisition cost for it to be considered a cost-effective strategy.