Cost-Effectiveness Analysis of talazoparib Maintenance Treatment for patients with germline BRCA1/2 mutated HER2-negative advanced breast cancer in China and the US

Abstract

Abstract Objective: Breast cancer is one of the tumors with the highest prevalence rate among women in the world, and its BRCA1/2 gene is a common mutation site. Talazoparib, as a targeted PARP inhibitor, can effectively control the occurrence and development of breast cancer with BRCA1/2 gene mutation, and play a therapeutic role. Based on the phase III EMBRACE trial (NCT01945775 clinical trial), this paper aims to use Talazoparib's scheme to treat HER2-negative advanced breast cancer and obtain the economic cost-effectiveness of Talazoparib. This article conducts a cost-benefit analysis of the treatment regimen for Talazoparib from the perspectives of Chinese and American patients. Methods: To evaluate the cost-effectiveness of Talazoparib more scientifically and provide clinicians with chemotherapy options, this paper developed a Markov model based on the EMBRACA clinical trial (clinical Trails.gov No., NCT01945775) to simulate the survival events of breast cancer patients in the Talazoparib group and the standard treatment group. The state transition probability and clinical data of breast cancer patients during treatment were extracted from the phase III EMBRACA clinical trial. The cost data generated during the treatment process comes from local hospital pricing, other references, and expert consultation. This article uses US dollars to calculate the treatment cost and incremental cost-effectiveness ratio. Health outcomes are expressed in Quality Adjusted Life Years (QALYs). In addition, 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: This article establishes a Markov model for single-item sensitivity analysis. The results show that the economic benefits of using Talazoparib as a new treatment strategy in both China and the United States are higher than other drugs, and it is cost-effective. Compared to the control group, the incremental cost incurred by the Talazoparib treatment group in China was $2484.48/QALY, with an incremental QALY of 1.5. However, Talazoparib in the United States holds a dominant position, saving costs of $10223.43 and increasing QALYs by 1.5. Conclusion: Through pharmacoeconomic analysis, this paper found that when the QALY thresholds in China and the United States were 3185 US dollars/month and 19100 US dollars/month respectively, the maintenance treatment of Talazoparib for HER2 negative advanced breast cancer patients with BRCA1/2 gene mutation was more cost-effective than that of Eribulin, Gemcitabine and Capecitabine. So, Talazoparib is expected to become a new treatment option.