Cost-effectiveness analysis of trastuzumab emtansine for second-line treatment of HER2+ advanced breast cancer in Singapore.

IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Wei Han Melvin Wong, Raymond Ng, Mohamed Ismail Abdul Aziz, Benjamin Shao-Kiat Ong, Kwong Ng
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Abstract

Objective: To evaluate the cost-effectiveness of trastuzumab emtansine (T-DM1) compared to both lapatinib plus capecitabine (lapcap) and trastuzumab plus capecitabine (trascap) for treating human epidermal growth factor 2-positive advanced breast cancer patients, who have received prior treatment with trastuzumab and a taxane, in Singapore.

Research design and methods: A three-state partitioned survival model was used to evaluate the cost-effectiveness from the local healthcare system perspective. Key effectiveness data, including progression-free survival and overall survival from the pivotal EMILIA trial, were used alongside local clinician inputs. Health state utilities (in quality-adjusted life years [QALYs]) were obtained from the literature and direct medical costs obtained from the public health institutions in Singapore. Scenario, one-way, and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on cost-effectiveness.

Results: The base-case incremental cost-effectiveness ratios (ICERs) for T-DM1, compared to lapcap and trascap, were S$472,600 and S$495,200 per QALY gained, respectively. Sensitivity and scenario analyses showed high ICERs, with a 50% price reduction for T-DM1 resulting in an ICER above S$200,000.

Conclusion: At current prices, T-DM1 is unlikely to be a cost-effective use of Singapore's limited healthcare budget. These findings can help inform policymakers, alongside other considerations, on funding decisions.

曲妥珠单抗emtansine在新加坡用于HER2+晚期乳腺癌二线治疗的成本-效果分析
目的:在新加坡评估曲妥珠单抗emtansine (T-DM1)与拉帕替尼加卡培他滨(lapcap)和曲妥珠单抗加卡培他滨(trascap)治疗人类表皮生长因子2阳性晚期乳腺癌患者的成本效益,这些患者之前接受过曲妥珠单抗和紫杉烷治疗。研究设计与方法:采用三状态分区生存模型,从地方医疗系统角度评估成本-效果。关键有效性数据,包括关键EMILIA试验的无进展生存期和总生存期,与当地临床医生的输入一起使用。从文献和从新加坡公共卫生机构获得的直接医疗费用中获得健康状态效用(以质量调整生命年[QALYs]计算)。采用情景分析、单向分析和概率敏感性分析来探讨不确定性对成本-效果的影响。结果:与便携式cap和便携式cap相比,T-DM1的基本情况增量成本效益比(ICERs)分别为每QALY获得472,600新元和495,200新元。敏感性和情景分析显示高ICERs, T-DM1降价50%导致ICERs超过20万新元。结论:以目前的价格,T-DM1不太可能是新加坡有限的医疗保健预算的成本效益的使用。这些发现可以帮助决策者在资金决策方面提供信息,同时考虑其他因素。
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来源期刊
Expert Review of Pharmacoeconomics & Outcomes Research
Expert Review of Pharmacoeconomics & Outcomes Research HEALTH CARE SCIENCES & SERVICES-PHARMACOLOGY & PHARMACY
CiteScore
4.00
自引率
4.30%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Expert Review of Pharmacoeconomics & Outcomes Research (ISSN 1473-7167) provides expert reviews on cost-benefit and pharmacoeconomic issues relating to the clinical use of drugs and therapeutic approaches. Coverage includes pharmacoeconomics and quality-of-life research, therapeutic outcomes, evidence-based medicine and cost-benefit research. All articles are subject to rigorous peer-review. The journal adopts the unique Expert Review article format, offering a complete overview of current thinking in a key technology area, research or clinical practice, augmented by the following sections: Expert Opinion – a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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