Objective: Breast cancer is the most common form of cancer among women in the United States. Triple-Negative breast cancer (TNBC) is the most aggressive form. Our objective was to perform a cost effectiveness analysis comparing paclitaxel monotherapy versus paclitaxel-bevacizumab combination therapy for TNBC.

Methods: We developed a state-transition Markov model to simulate clinical course of illness (health states: progression-free survival, progressive-disease, and death) among women diagnosed with TNBC. The simulated cohort was consistent with patients from the Eastern Cooperative Oncology Group (ECOG) 2100 trial, which included women with metastatic TNBC (mean age 55 years). The analysis was conducted from the US health care payer’s perspective and considered annual cycle length and life-time horizon. Outcomes were discounted at an annual discount rate of 3%. A Univariate Sensitivity analyses (1-way) and probabilistic sensitivity analysis (PSA) were carried out to evaluate parameter and decision uncertainty. All analyses were conducted using TreeAge Pro,Williamstown, MA.

Results: Lifetime cost and quality-adjusted life years (QALYs) for women who received paclitaxel monotherapy were $818606 and 2.57, respectively. Bevacizumab to Paclitaxel led to 0.03 additional QALYS and was associated with an incremental cost of $516848, leading to an incremental cost-effectiveness ratio of 17481580 per QALY. Univariate Sensitivity Analysis results show that probability of progression-free survival associated with the combination therapy contributed substantial uncertainty to the model followed by probability of progression free survival associated with the monotherapy. PSA show that Paclitaxel is cost-effective throughout the spectrum of willingness to pay thresholds on the graph

Conclusions: The combination therapy provides only marginal benefit but contributes to a substantial incremental lifetime cost of care. Our findings are consistent with previous literature on cost-effectiveness of these drugs in the US and provides a compelling reason to question the utilization of the combination therapy as a first-line therapy for TNBC.