Clinical and Economic Analysis of Effectiveness of Everolimus in the Treatment Of HR+, HER2- Advanced Breast Cancer in Russia

Abstract

Objectives: To assess the cost-effectiveness of Abiraterone Acetate plus Prednisone (A-P) compared with Cabazitaxel plus Prednisone (C-P) in Dominican Republic, in patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC) that have failed to chemotherapy with Docetaxel. MethOds: A three-health state cohort simulation Markov Model (progression-free, post-progression and death) was developed based on overall and progression free survival data. The time frame was 10 years. The perspective was that of the Public System of Health of Dominican Republic. The health outcomes of interest were Quality Adjusted Life Years (QALYs) and Life Years (LYs). Efficacy data was taken from clinical trials (COU-AA-301 for A-P and TROPIC for C-P). Utilities for health states and negative utilities for adverse events were estimated based on quality of life endpoints of the COU-AA-301 trial. The base year was 2012. All costs are presented in Dominican currency (Dominican Pesos -RD$). Costs and outcomes were discounted at 5%. Probabilistic sensitivity (PSA) analysis was performed to evaluate uncertainty surrounding the parameters. Results: A-P resulted in 0.79 QALYs and 1.35 LYs, per patient, respectively. C-P resulted in 0.71 QALYs and 1.28 LYs, per patient, respectively. Mean total costs per patient were: RD$ 2.204.289 for A-P and RD$ 2.732.365 for C-P. The results of the probabilistic sensitivity analysis showed that, when compared with C-Z, A-P was found dominant (associated with reduced costs and increased QALYs) in the majority of the iterations. A-P had a 75% probability of being cost effective, independent of the willingness to pay, when compared to C-P. cOnclusiOns: A-P can be considered cost-saving (dominant), when compared with C-P, in patients with Metastatic Castration-Resistant Prostate Cancer that have failed to chemotherapy with Docetaxel, from the perspective of the Public System of Health of Dominican Republic.

Everolimus-Based Therapy versus Chemotherapy among Patients with HR+/HER2− Metastatic Breast Cancer: Comparative Effectiveness from a Chart Review Study

“…The present comparative effectiveness findings are consistent with recent studies showing that HR+/HER2− mBC patients treated with everolimus-based therapy tended to have better OS [ 17 , 18 ] and PFS [ 19 ] than those treated with chemotherapy. For example, using a small sample of HR+/HER2− mBC patients, Pouget et al showed that everolimus plus endocrine therapy resulted in significantly longer OS than chemotherapy for patients pretreated with two or fewer lines of therapies for mBC [ 17 , 18 ].…”

“…The present comparative effectiveness findings are consistent with recent studies showing that HR+/HER2− mBC patients treated with everolimus-based therapy tended to have better OS [ 17 , 18 ] and PFS [ 19 ] than those treated with chemotherapy. For example, using a small sample of HR+/HER2− mBC patients, Pouget et al showed that everolimus plus endocrine therapy resulted in significantly longer OS than chemotherapy for patients pretreated with two or fewer lines of therapies for mBC [ 17 , 18 ]. Cope et al (2013) conducted a network meta-analysis of available mBC clinical trials and concluded that despite differences in patient characteristics across studies, everolimus/exemestane combinational therapy was associated with the longer mean PFS until 20 months compared to commonly-used chemotherapies such as capecitabine, doxorubicin, paclitaxel, and vinorelbine [ 19 ].…”

“…The current NCCN guidelines recognize this and support subsequent treatment to prolong the benefits of endocrine therapies for as long as possible before initiating chemotherapy [ 8 ]. Together with recent studies [ 17 , 18 ], the current findings suggest that everolimus-based therapy may be a more effective alternative to chemotherapy after initial failure of nonsteroidal AIs. Furthermore, previous studies have shown that while everolimus may result in some moderate toxicity [ 23 , 24 ], the adverse events are generally manageable [ 25 ] and the patient's health-related QOL is similar to that of patients on endocrine therapy [ 26 ].…”

“…Currently, there is limited evidence regarding the comparative effectiveness of everolimus-based therapy and chemotherapy, two common treatment options for HR+/HER2− mBC after initial failure of nonsteroidal AI. Several recent studies presented in oncology conferences have indicated that everolimus/exemestane combinational therapy was associated with significantly longer survival compared to chemotherapies [ 17 , 18 ], but these studies were based on small samples of patients [ 17 ] or physician surveys [ 18 ]. A network meta-analysis of previous mBC trials also found that everolimus/exemestane combinational therapy was associated with comparable or better PFS compared to some commonly-used chemotherapy; however, findings in clinical trial settings may not represent the real-world comparative effectiveness.…”