COST EFFECTIVENESS ANALYSIS OF EVEROLIMUS + EXEMESTANE FOR PATIENTS WITH ADVANCED BREAST CANCER WITH POSITIVE ESTROGEN RECEPTOR (ER +), HER2-, REFRACTORY TO NON-STEROIDAL AROMATASE INHIBITORS (NSAIS) IN CHILE
Author(s)
Ratto B1, Torres Ulloa R2, Cerda Veneros H2, Anaya P3
1Novartis Pharmaceuticals, Buenos Aires, Argentina, 2INSTITUTO NACIONAL DEL CÁNCER, Santiago, Chile, 3Novartis Pharmaceuticals, Mexico City, Mexico
OBJECTIVES: To evaluate the cost-effectiveness of everolimus plus exemestane in patients with ER+, HER2- advanced breast cancer, who have failed on NSAIs. METHODS: A Markov model was developed with monthly cycles and a time horizon of five years. The model compares progression free survival (PFS) of exemestane + everolimus (EVE+EXE) to exemestane monotherapy (EXE). Transition probabilities for PFS of EVE+EXE and EXE were based on BOLERO-2 study and calculated using a fitted Weibull distribution. The R-squared values for the Weibull fits were 0.998 and 0.990 for EVE+EXE and EXE alone respectively. The Weibull parameters used in the model were: 0.067 and 1.118 for EVE+EXE and 0.191 and 1.006 for EXE. Costs considered included drugs and cost of treating neutropenia (other AEs are not covered by the National Formulary). The analysis was designed from the perspective of the Chilean Public Healthcare. Results are shown in 2014 Chilean pesos. A 5% discount rate for costs and efficacies was applied. A probabilistic sensitivity analysis (PSA) was run with thousand repetitions and a one-way sensitivity analysis was calculated showing its results in a tornado chart. RESULTS: The model showed that everolimus + exemestane results in 0.74 progression free years gained with an incremental cost of $18.6 million (MM) resulting in an incremental cost-effectiveness ratio (ICER) of $26 MM. The PSA showed that the ICER is within the range recommended by WHO (1-3 GDPs per capita) in 71% of cases (Currently the GDP per capita in Chile is $10 MM). CONCLUSIONS: This analysis showed that using everolimus plus exemestane in patients with ER +, HER2- advanced breast cancer who have failed on NSAIs is a cost-effective option according to WHO recommendations.
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PCN115
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology