Cost-effectiveness of treatments for HER2-positive metastatic breast cancer and associated metastases: an overview of systematic reviews

ABSTRACT

Introduction: Treatment of human epithelial growth factor receptor 2 (HER2)-positive breast cancer has rapidly evolved over the past decades with the addition of trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1). These treatments have dramatically impacted the survival of HER2-positive metastatic breast cancer (mBC) patients. Nonetheless, these agents are associated with high price tags, begging the question, ‘Are treatments for HER2-positive metastatic breast cancer and associated metastases cost-effective’?

Areas covered: We examine evidence on the cost-effectiveness of treatments for HER2-positive metastatic breast cancer and associated metastases through a review of systematic reviews on the topic. Additionally, we discuss the implications of our findings and provide recommendations for future directions in the assessment of the cost-effectiveness of targeted directed agents for HER2-positive mBC.

Expert opinion: Heterogeneous evidence from cost-effectiveness studies on the use of targeted directed agents for HER2-positive mBC across the world caution against cross-country comparisons of the value of such treatments. It also militates in favor of the production and use of cost-effectiveness analyses for local rather than global decision-making, thus ensuring that economic evaluations reflect the needs of local decision-makers and populations for which they are devised.

KEYWORDS:

• Breast cancer
• metastases
• her2-positive receptors
• cost-effectiveness
• systematic review

Article highlights

• Results of cost-effectiveness analyses of HER2-positive metastatic breast cancer (mBC) were heterogeneous, with a limited number of studies showing cost-effective results at different willingness to pay thresholds.

• Factors influencing the estimation of the value for these treatment regimens include the perspective of the study, the line of therapy, country, the measure of effectiveness, and the willingness to pay (WTP) threshold used.

• Production and use of cost-effectiveness analyses (CEAs) for local (country-wide) rather than global decision-making to ensure economic evaluations reflect the needs of local decision-makers and populations for which they are conducted.

• With better access to big and real-world data, there is an opportunity to conduct more observational-based cost-effectiveness analyses to support decision-making from a real-world perspective.

• Efforts towards broadening the definition of value in health care and incentivizing research (new funding mechanisms) on how to incorporate elements of value into cost-effectiveness analyses beyond traditional quality-adjusted life years and fostering patient-centeredness in decision-making are underway.

• Newer and expansive medications, that otherwise would not be found cost-effective, could now become more cost-effective given those additional elements of value would be considered should the definition of value broadens.

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.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

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Additional information

Funding

This paper was not funded.