COST-UTILITY ANALYSIS OF NEOADJUVANT CHEMOTHERAPY WITH PERTUZUMAB, TRASTUZUMAB AND DOCETAXEL IN PATIENTS WITH HER2+ BREAST CANCER IN SPAINCOST-UTILITY ANALYSIS OF NEOADJUVANT CHEMOTHERAPY WITH PERTUZUMAB, TRASTUZUMAB AND DOCETAXEL IN PATIEN ...
Author(s)
Colomer R1, Ciruelos E2, De la Haba J3, Martín M4, De Salas-Cansado M5, Muñoz-Molina B5, Albanell J6
1Hospital Universitario La Princesa, Madrid, Spain, 2Hospital Universitario 12 de Octubre, Madrid, Spain, 3Hospital Universitario Reina Sofía, Córdoba, Spain, 4Hospital Universitario Gregorio Marañón, Madrid, Spain, 5Roche Farma, Madrid, Spain, 6Hospital del Mar, Barcelona, Spain
OBJECTIVES: In the NeoSphere trial, patients with HER2+ breast cancer (BC) treated with neoadjuvant chemotherapy with pertuzumab, trastuzumab and docetaxel (PTD) showed improved pathological complete response (pCR) compared to patients treated with trastuzumab and docetaxel (TD). This benefit is estimated to result in the prevention of 5% relapses at 5-years. The aim of this study was to determine the cost-utility of PTD vs. TD in Spain. METHODS: A six-state Markov model (event-free, locoregional-relapse, remission, metastatic-relapse [1L], metastatic-relapse [2L], and death) was developed to perform a cost-utility analysis of PTD vs TD from the perspective of the Spanish National Healthcare System (NHS) over a lifetime horizon. Event free survival (EFS) was estimated fitting a log-logistic distribution to EFS data from NeoSphere. Transition probabilities, utilities and unit costs were derived from literature, a 15-oncologists Delphi panel and national databases. A discount rate of 3% was applied to both costs and effects. The use of resources and the efficacy assumptions were validated by an expert panel. Uncertainties were explored in univariate and probabilistic sensitivity analyses (SA). Cost-utility was also evaluated in an alternative scenario in which pCR results from the NeoSphere study were combined with EFS data from the CTNeoBC analysis. RESULTS: In the base case, PTD was dominant over PT with a gain of 0.560 Quality Adjusted Life Years (QALYs) and savings of €7,230. In the univariate SA, PTD remained dominant over a wide range of assumptions. In the probabilistic SA, PTD was dominant or cost-effective at a threshold of €30,000 in 91% of simulations. PTD was also dominant in the alternative scenario based on pCR results, resulting in a gain of 0.494 QALYs and savings of €3,792. CONCLUSIONS: In addition to the clinical benefit reported, the combination of PTD in HER2+ BC patients receiving neoadjuvant therapy would result in QALY gains and cost savings for the NHS.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PCN175
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology