Cost-Effectiveness of Tucatinib in Human Epidermal Growth Factor Receptor 2–Positive Metastatic Breast Cancer From the US and Chinese Perspectives

Abstract

Background: The clinical evaluation of HER2CLIMB trial showed a 21. 9-month median overall survival with the triplet regimens of tucatinib, capecitabine, and trastuzumab (TXT) for patients with human epidermal growth factor receptor 2 (HER2) –overexpressing metastatic breast cancer. From the payer's perspective of the United States and China, a cost-effectiveness analysis was conducted to evaluate the costs and benefits of adding tucatinib in this study. Methods: We constructed a Markov model for the economic evaluation of adding tucatinib to trastuzumab plus capecitabine in patients with HER-2 positive metastatic breast cancer in the United States and China. The model was conducted with a 10-year time horizon, and the health status was divided into three states: progression-free survival, progressing disease, and death. The health utility scores were consistent with published literature with similar patient status. The transition probabilities were derived from the survival data of the HER2CLIMB study. The unit prices of medicines were obtained from the West China Hospital, Red Book, and published literature. Outcomes were measured in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio, which robustness was evaluated by deterministic and probabilistic sensitivity analyses. Results: Compared with the two-drug regimen of trastuzumab plus capecitabine (TX), the addition of tucatinib increased 0.21 QALY, with an increasing cost of $146,995.05 and $19,022.97 in the United States and China, respectively. The incremental cost-effectiveness ratios (ICERs) for the TXT versus TX was $699,976.43 in the U.S. and $90,585.57 in China, both of which are higher than their respective threshold of willingness to play. Deterministic sensitivity analysis shows that the price of tucatinib is the parameter that has the most significant impact on ICERs, but it does not change the results of the model. Probability sensitivity analysis shows that the probability of cost-effective for TXT is 0 in the base case. Conclusion: In the United States and China, tucatinib combined with trastuzumab and capecitabine is not cost-effective for patients with HER-2 positive metastatic breast cancer.

A cost-effectiveness analysis of capecitabine maintenance therapy versus routine follow-up for early-stage triple-negative breast cancer patients after standard treatment from a perspective of Chinese society

“…Time-dependent state-transition probabilities in each cycle were calculated using the formula at a given cycle t in the Markov model, where represents the survival probability at time t using parameters ( μ , σ ) of Log-normal in Table 1 [ 37 , 39 , 40 ]. The transition probability from DFS to death was set as the age-specific natural mortality rate of the general Chinese women population in 2020 [ 41 ], according to previous literature [ 42 , 43 ]. A time-dependent transition probability matrix sample is presented in Table S4 (Additional file 1 ).…”

Trastuzumab deruxtecan versus trastuzumab emtansine for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: A cost-effectiveness analysis

“…Chinese drug prices come from Xiangya Hospital of Central South University. The remaining costs are derived from published literature [ 20 , 21 , 27 , [29] , [30] , [31] , [32] , [33] , [34] , [35] ]. Based on the US Consumer Price Index (CPI), healthcare-related costs were inflated to 2021 values in the US [ 36 ].…”

Trastuzumab deruxtecan versus chemotherapy for patients with HER2-low advanced breast cancer: A US-based cost-effectiveness analysis

“…The prices of the drugs that were used were obtained from the official website for drug research ( CMS, 2022 ). The remaining costs were derived come from published literature ( Le et al, 2016 ; Wan et al, 2019 ; Zhang et al, 2019 ; Han et al, 2020 ; Wu et al, 2020 ; Liu et al, 2021 ; Wang et al, 2021 ; Zhu et al, 2021 ) ( Table 1 ). According to the changes in prices paid by US consumers, the healthcare-related costs have been adjusted to the inflation rate in the United States for 2022 ( US Bureau of Labor Statistics, 2022 ).…”