Reviewing the quality, health benefit and value for money of chemotherapy and targeted therapy for metastatic breast cancer

Abstract

PurposeTo provide an overview of model characteristics and outcomes of model-based economic evaluations concerning chemotherapy and targeted therapy (TT) for metastatic breast cancer (MBC); to assess the quality of the studies; to analyse the association between model characteristics and study quality and outcomes.MethodsPubMED and NHS EED were systematically searched. Inclusion criteria were as follows: English or Dutch language, model-based economic evaluation, chemotherapy or TT as intervention, population diagnosed with MBC, published between 2000 and 2014, reporting life years (LY) or quality-adjusted life-year (QALY) and an incremental cost-effectiveness ratio. General characteristics, model characteristics and outcomes of the studies were extracted. Quality of the studies was assessed through a checklist.Results24 studies were included, considering 50 comparisons (20 concerning chemotherapy and 30 TT). Seven comparisons were represented in multiple studies. A health state-transition model including the following health states: stable/progression-free disease, progression and death was used in 18 studies. Studies fulfilled on average 14 out of the 26 items of the quality checklist, mostly due to a lack of transparency in reporting. Thirty-one per cent of the incremental net monetary benefit was positive. TT led to higher iQALY gained, and industry-sponsored studies reported more favourable cost-effectiveness outcomes.ConclusionsThe development of a disease-specific reference model would improve the transparency and quality of model-based cost-effectiveness assessments for MBC treatments. Incremental health benefits increased over time, but were outweighed by the increased treatment costs. Consequently, increased health benefits led to lower value for money.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-017-4374-6) contains supplementary material, which is available to authorized users.

An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

“…The results of this systematic review confirm several of the points made by Pouwels et al [1]. One of the main takeaways from the Pouwels et al study was that treatments for MBC did not provide good value for money and that ICERs did not meet typical willingness to pay thresholds.…”

“…Of the 256 identified articles, 67 of the articles were published after October 2014 when the prior systematic review stopped its assessment [1]. From the 67 articles, we narrowed down to include 17 original health economic analyses specific to metastatic or advanced breast cancer.…”

“…The search yielded 256 articles for review. We excluded studies published prior to October 2014 [1]. This narrowed the results to 67 articles, whose titles and abstracts were screened.…”

“…In 2017, Pouwels et al conducted a review of economic analyses published between January 2000 and October 2014 for metastatic breast cancer treatments [1]. Since 2014, five new compounds have been approved for MBC and a number of studies have been published addressing the cost-effectiveness of new and existing regimens.…”

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Objective: The goal of this systematic review is to provide an update to the review by Pouwels et al by conducting a systematic review and an assessment of the reporting quality of the economic analyses conducted since 2014.

Methods: This systematic review identified published articles focused on metastatic breast cancer treatment using the Medline/PubMed and Scopus databases and the following search criteria: (((cost effectiveness[MeSH Terms]) OR (cost effectiveness) OR (cost-effectiveness) OR (cost utility) OR (cost-utility) OR (economic evaluation)) AND ((“metastatic breast cancer”) OR (“advanced breast cancer”))). The reporting quality of the included articles was evaluated using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Results: Of the 256 identified articles, 67 of the articles were published after October 2014 when the prior systematic review stopped its assessment [1]. From the 67 articles, we narrowed down to include 17 original health economic analyses specific to metastatic or advanced breast cancer.

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