Neratinib plus capecitabine versus lapatinib plus capecitabine as the third-line therapy for HER2-positive metastatic breast cancer in China: a cost-effectiveness analysis

Abstract

ObjectiveNeratinib plus capecitabine (Ner+Cap) were proved to be clinically beneficial as a third-line treatment for women with human epidermal growth factor receptor-2 (HER2) positive metastatic breast cancer (MBC). The objective of this study was to evaluate the cost-effectiveness of Ner+Cap from the Chinese healthcare perspective.DesignA three-state Markov simulation model was performed based on the results of NALA trial. The utilities of health state and disutilities of adverse events were derived from the published literature. Direct costs of anticancer agents, drug administration, routine follow-up and serious adverse events management were calculated in the model. Uncertainty was evaluated through univariate and probability sensitivity analysis.ParticipantsPatients with confirmed HER2-positive MBC who previously received at least two HER2-targeted treatments and were aged ≥18 years with an Eastern Cooperative Oncology Group performance status 0 or 1. A total of 621 patients were enrolled in the NALA trial.InterventionsThird-line treatment with Ner+Cap or lapatinib plus capecitabine (Lap+Cap).Main outcome measuresThe primary health outcomes of the model were costs, expected life-years (LYs), quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs).ResultsWhen compared with Lap+Cap, Ner+Cap provided an additional 0.431 LYs and 0.339 QALYs, and increased the cost by $4299.2. The corresponding ICERs were 9970.1/LY and $12 670.2/QALY. Univariate sensitivity analyses suggested that the results were generally robust. Besides, Ner+Cap had a 100% probability of being cost-effective according to probabilistic sensitivity analysis.ConclusionsNer+Cap was likely to be a cost-effective regimen as the third-line therapy for women with HER2-positive MBC at the willingness-to-pay threshold of $37 653.0/QALY in China.

A comprehensive clinical evaluation of HER2-TKIs in patients with previously treated HER2-positive metastatic breast cancer

“…Pyrotinib + capecitabine was found to have an advantage over lapatinib + capecitabine in cost-utility with higher QALYs and lower cost [30,31]. Compared with lapatinib + capecitabine, the cost-utility value of neratinib +capecitabine was more superior [32,33]. It is worth mentioning that the medical insurance indication of neratinib is HER2-positive early BC and lapatinib was moved out from the insurance list in 2021.…”

Neratinib for HER2-positive breast cancer with an overlooked option

“…In the NALA study, higher HER2 expression was associated with a greater benefit for neratinib plus capecitabine compared with lapatinib plus capecitabine(Saura et al 2021 ). Compared to lapatinib plus capecitabine, neratinib plus capecitabine was likely to be a cost-effective regimen as third-line therapy for women with HER2-positive MBC (Wu et al 2022 ). There data may suggest that neratinib has a better efficacy than lapatinib, with enhanced cost-effectiveness and without increased toxicity.…”