Abstract
Background: Breast cancer is one of the most common malignant tumors in women. Human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer has poor prognosis and short survival period. EMILIA was a global phase III study to evaluate the efficacy of Trastuzumab emtansine (T-DM1) and Capecitabine plus lapatinib. However, the cost-effectiveness of T-DM1 is still unclear. Therefore, the objective of this study was to evaluate the cost-effectiveness of T-DM1 and Capecitabine plus lapatinib in treating HER2-positive advanced breast cancer within 5 years from the perspective of Chinese payers.
Methods: A half cycle adjusted Markov model was established to simulate the process of health status transfer and death of breast cancer patients under the treatment of T and CL schemes, so as to evaluate the cumulative lifetime costs, incremental cost-benefit ratio (ICER), and quality adjusted life year (QALY) of Chinese patients. The parameters of the input model were from the EMILIA Phase III study. In order to determine the stability of the model, we also conducted single factor sensitivity analysis and probability sensitivity analysis.
Results: Markov model analysis results showed that compared with Capecitabine plus lapatinib, T-DM1 treatment generates an additional 0.4QALY and an incremental cost of $12282.97. The ICER of T versus CL was $30707.405/QALY and did not exceed Chinese willingness-to-pay (WTP) threshold.
Conclusions: Compared with Capecitabine plus lapatinib, T-DM1 treatment can bring better health benefits to patients with breast cancer and is likely to be cost-effective second-line therapies for HER2-positive breast cancer in China.