Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer
OBJECTIVE To evaluate the cost-effectiveness of trastuzumab deruxtecan(T-DXd)versus trastuzumab emtansine(T-DM1)in the second-line treatment of HER2-positive metastatic breast cancer,and to provide a basis for the selection of clinical medication regimen and medical and health decisions.METHODS Based on the clinical trial DESTINY-Breast03,a partitioned survival model was constructed,with a cycle of 3 weeks as the simulation of patients'lifetime.The incremental cost-effectiveness ratio(ICER)was calculated by using quality-adjusted life years(QALY)as output indicators,and sensitivity analysis was used to verify the robustness of the basic analysis results;the cost-effectiveness of the second-line treatment for HER2-positive metastatic breast cancer was compared between T-DXd and T-DM1.RESULTS Under the premise of taking 3 times China's per capita gross domestic product(GDP)in 2022 as the willingness-to-pay threshold(257 094 yuan/QALY),the T-DXd group also needed to pay more cost compared with T-DM1 group while obtaining incremental utility(0.69 QALYs),and the ICER value was 1 850 478.40 yuan/QALY.The results of univariate sensitivity analysis showed that progression-free survival state utility value,T-DXd price,cost discount rate were factors that had a great influence on ICER value,but these parameters could not flip the basic analysis results within a reasonable range.In the probability sensitivity analysis,when the threshold of willingness-to-pay rose to 1 500 400 yuan/QALY,the probability of economic activity was 50%in the T-DXd regimen.The results of the scenario analysis also verified the robustness of the original research results.CONCLUSIONS Under the premise of 3 times China's per capita GDP as the WTP threshold,compared with T-DM1,T-DXd is not cost-effective in the second-line treatment of HER2-positive metastatic breast cancer.
trastuzumab deruxtecantrastuzumab emtansineHER2-positive metastatic breast cancerpartitioned survival modelcost-utility analysis
国家科技期刊平台
NSTL
万方数据
维普
