Cost-effectiveness analysis of trastuzumab deruxtecan in patients with HER2-low advanced breast cancer based on DESTINY-Breast04

Frontiers in Public Health

Public Health

Ting Xu¹  Hanrui Zheng¹  Fengbo Wu¹  Zijia Huang¹  Mei Zhan¹  Xinyi Xu² 

[1] Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China;West China School of Pharmacy, Sichuan University, Chengdu, China;West China School of Pharmacy, Sichuan University, Chengdu, China;

关键词: cost-effectiveness;    breast cancer;    HER2-low;    trastuzumab deruxtecan;    chemotherapy;   

DOI  :  10.3389/fpubh.2023.1049947

 received in 2022-09-21, accepted in 2023-06-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background and purposeBreast cancer is a rapidly raising healthcare problem worldwide. DESTINY-Breast04 demonstrated that trastuzumab deruxtecan (T-Dxd) had a survival advantage comparing to the physician's choice of chemotherapy for patients with HER2-low metastatic breast cancer. But at the same time, this expensive novel treatment also brought an economic burden. This study assessed the cost-effectiveness of T-Dxd based on results of DESTINY-Breast04 from the perspective of Chinese healthcare system.Materials and methodsA three-state partitioned-survival model [progression-free survival (PFS), progressive disease (PD) and death] based on data from DESTINY-Breast04 and Chinese healthcare system was used to estimate the incremental cost-effectiveness ratio (ICER) of T-Dxd vs. the physician's choice of chemotherapy for HER2-low metastatic breast cancer. Costs, quality-adjusted life-years (QALYs) and the ICER in terms of 2022 US$ per QALY gained were calculated for both hormone receptor–positive cohort and all patients. One-way and probabilistic sensitivity analyses were performed to assess the model robustness.ResultsCompared with the physician's choice of chemotherapy, T-Dxd increased costs by $104,168.30, while gaining 0.31 QALYs, resulting in an ICER of $336,026.77 per QALY in all patients. The costs of T-Dxd and the utility of PFS were the crucial factors in determining the ICER. In the hormone receptor–positive cohort, the ICER was lower than that in all patients, with the ICER of $274,905.72 per QALY. The ICER was much higher than the commonly accepted willingness-to-pay threshold ($357,96.83 per QALY).ConclusionT-Dxd as second- or subsequent-line treatment is not a cost-effective treatment option for HER2-low metastatic breast cancer from the perspective of the Chinese healthcare system.

【 授权许可】

Unknown   
Copyright © 2023 Zhan, Huang, Xu, Xu, Zheng and Wu.