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ABSTRACT
Objective: To provide perspective for the National Health Insurance Bureau (NHIB), we determined the cost-effectiveness of pertuzumab combined with trastuzumab and docetaxel (TDP) versus trastuzumab and docetaxel (TD) as a first-line treatment for HER-2 positive metastatic breast cancer.
Methods: We used a Markov model to simulate cost-effectiveness, disease progression, and survival, based on clinical data and transition probabilities extracted from the CLEOPATRA study. Direct medical costs were acquired from the NHIB claims database.The utilities in health state were based on a recent cost-effectiveness study on trastuzumab and pertuzumab. Outcomes included quality-adjusted life-years (QALYs), costs in New Taiwan dollars (NT$), and the incremental cost-effectiveness ratio (ICER). We performed one-way deterministic and probabilistic sensitivity analyses to assess the impact of specific parameters on the model.
Results: Modeled median survival was 39.1 months for TD and 50.1 months for TDP. The ICER was NT$18,999,687 (US$593,741) per QALY gained. The sensitivity analyses indicated that TDP could be cost-effective under favorable assumptions; TDP had a 68% chance of being cost-effective, if TDP costs could be reduced with 10% in the stable disease state.
Conclusion: Our model predicted that TDP would be cost-effective as a first-line treatment for HER-2 positive metastatic breast cancer, but only under favorable drug cost assumptions.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose
Additional information
Funding
Notes on contributors
Henry W. C. Leung
H.W.L. designed the study and wrote the paper. A.L.F.C. built the model and analyzed the data. C.H.M. retrieved data from the NHIB database. All authors discussed the results and contributed to editing the paper.
Agnes L. F. Chan
H.W.L. designed the study and wrote the paper. A.L.F.C. built the model and analyzed the data. C.H.M. retrieved data from the NHIB database. All authors discussed the results and contributed to editing the paper.
Chih-Hsin Muo
H.W.L. designed the study and wrote the paper. A.L.F.C. built the model and analyzed the data. C.H.M. retrieved data from the NHIB database. All authors discussed the results and contributed to editing the paper.
John Hang Leung
H.W.L. designed the study and wrote the paper. A.L.F.C. built the model and analyzed the data. C.H.M. retrieved data from the NHIB database. All authors discussed the results and contributed to editing the paper.