Cost-Effectiveness Analysis of Pertuzumab with Trastuzumab and Chemotherapy Compared to Trastuzumab and Chemotherapy in the Adjuvant Treatment for Patients with HER2-Positive EARLY Breast Cancer- Update Results after National Drug Reimburse ...
Author(s)
Guan X1, Li HC1, Chen QJ2, Hao CF3, Li JJ4, Wang YS5, Zhang J4, Xu H6, Liu C7, Yang Q7, Ma AX1
1China Pharmaceutical University, Nanjing, China, 2Guangdong Traditional Chinese Medical Hospital, Guangzhou, China, 3Tianjin Medical University Cancer Hospital, Tianjin, China, 4Fudan University Shanghai Cancer Center, Shanghai, China, 5Shandong Cancer Hospital, Jinan, China, 6China Pharmaceutical University, Nanjing, 32, China, 7Shanghai Roche Pharmaceuticals Ltd, Shanghai, China
OBJECTIVES : To estimate the cost-effectiveness of pertuzumab with trastuzumab and chemotherapy (PHT) vs trastuzumab and chemotherapy (HT) as the adjuvant treatment for patients with HER2-positive early breast cancer after National Drug Reimbursement List (NDRL) adjustment in China. METHODS : A 6-state Markov model cycle was constructed to estimate the lifetime incremental cost-effectiveness ratio (ICER). Main clinical input was the time spent in invasive Disease Free Survival state, estimated by extrapolations from the Chinese subgroup data in clinical trial APHINITY. Utilities were mainly calculated from EQ-5D of Chinese patients in APHINITY. Cost inputs comprised drugs, administration, adverse events management costs, follow-up and therapeutic costs. Furthermore, indirect costs were included when analyzed from society perspective. All costs were mainly obtained from real world data and local published resources. Sensitivity analyses were conducted to verify the robustness of the results. RESULTS : For ITT patients, PHT provided 0.79 more QALYs with additional costs than HT. Acquisition cost of pertuzumab is partially offset by the prevention of recurrences over the time. The ICER was CNY 68,484/QALY from healthcare system perspective and CNY 59,614/QALY from society perspective. For patients at high risk of recurrence, PHT provided 1.01 more QALYs and the ICER was CNY 33,920/QALY from healthcare system perspective. Further 32% lower indirect costs in PHT group resulting ICER of CNY 107,400/QALY from society perspective. Both ICERs were below GDP per capita (CNY 70,892), far below the local threshold of 3 times GDP per capita. One-way sensitivity analysis showed the results were generally robust. Probabilistic sensitivity analysis showed that PHT was more cost-effective in above 80% simulations at local threshold regardless of the perspective and patients. CONCLUSIONS : Compared to HT, PHT is more cost-effective as the adjuvant treatment for patients with HER2-positive early breast cancer, especially for patients at high risk of recurrence, after NDRL adjustment in China.
Code
PCN31