Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer
<h4>Objective</h4> The clinical efficacy and safety profile of trastuzumab deruxtecan (T-DXd) have been demonstrated in previously treated patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer (BC). It is, however, necessary to evaluate the value of T-D...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449172/?tool=EBI |
| _version_ | 1797736606987190272 |
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| author | Demin Shi Xueyan Liang Yan Li Lingyuan Chen |
| author_facet | Demin Shi Xueyan Liang Yan Li Lingyuan Chen |
| author_sort | Demin Shi |
| collection | DOAJ |
| description | <h4>Objective</h4> The clinical efficacy and safety profile of trastuzumab deruxtecan (T-DXd) have been demonstrated in previously treated patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer (BC). It is, however, necessary to evaluate the value of T-DXd considering both its clinical efficacy and its cost, given that it is high. This study aimed to evaluate the cost-effectiveness of T-DXd versus chemotherapy in patients with previously treated HER2-low advanced BC. <h4>Methods</h4> We used a partitioned survival model that included three mutually exclusive health states. The patients in the model were identified based on their clinical characteristics and outcomes from the DESTINY-Breast04. Probabilistic and one-way sensitivity analyses were performed to evaluate the model’s robustness. Subgroup analyses were also conducted. The measures included costs, life years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net health benefits (INHBs), and incremental net monetary benefits (INMBs). <h4>Results</h4> The ICERs of T-DXd vs. chemotherapy were $83,892/QALY, $82,808/QALY, and $93,358/QALY in all HER2-low advanced BC patients, HER2-positive (HER2+) advanced BC patients and HER2-negative (HER2-) advanced BC patients, respectively. In one-way sensitivity analysis, the cost of T-DXd and hazard ratio (HR) for progression-free survival (PFS) and overall survival (OS) were also identified as key drivers. If the price of T-DXd decreased to $17.00/mg, $17.13/mg, and $14.07/mg, it would be cost-effective at a willingness to pay (WTP) threshold of $50,000/QALY in all HER2-low advanced BC patients, HER2+ advanced BC patients and HER2- advanced BC patients, respectively. At a WTP threshold of $100,000/QALY, the probability of T-DXd being cost-effective was 81.10%, 82.27%, and 73.78% compared to chemotherapy for all HER2-low advanced BC patients, HER2+ advanced BC patients and HER2- advanced BC patients, respectively. Most subgroups of patients with HER2+ disease had a cost-effectiveness probability of > 50%. <h4>Conclusion</h4> From a third-party payer’s perspective in the United States, the findings of the cost-effectiveness analysis revealed that, at the current price, T-DXd is a cost-effective alternative to chemotherapy for patients with prior HER2-low advanced BC, at WTP threshold of $100,000/QALY. |
| first_indexed | 2024-03-12T13:16:20Z |
| format | Article |
| id | doaj.art-3c63599b45b94efa950007e4391372a7 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-12T13:16:20Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-3c63599b45b94efa950007e4391372a72023-08-27T05:32:03ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01188Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancerDemin ShiXueyan LiangYan LiLingyuan Chen<h4>Objective</h4> The clinical efficacy and safety profile of trastuzumab deruxtecan (T-DXd) have been demonstrated in previously treated patients with human epidermal growth factor receptor 2 (HER2)-low advanced breast cancer (BC). It is, however, necessary to evaluate the value of T-DXd considering both its clinical efficacy and its cost, given that it is high. This study aimed to evaluate the cost-effectiveness of T-DXd versus chemotherapy in patients with previously treated HER2-low advanced BC. <h4>Methods</h4> We used a partitioned survival model that included three mutually exclusive health states. The patients in the model were identified based on their clinical characteristics and outcomes from the DESTINY-Breast04. Probabilistic and one-way sensitivity analyses were performed to evaluate the model’s robustness. Subgroup analyses were also conducted. The measures included costs, life years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net health benefits (INHBs), and incremental net monetary benefits (INMBs). <h4>Results</h4> The ICERs of T-DXd vs. chemotherapy were $83,892/QALY, $82,808/QALY, and $93,358/QALY in all HER2-low advanced BC patients, HER2-positive (HER2+) advanced BC patients and HER2-negative (HER2-) advanced BC patients, respectively. In one-way sensitivity analysis, the cost of T-DXd and hazard ratio (HR) for progression-free survival (PFS) and overall survival (OS) were also identified as key drivers. If the price of T-DXd decreased to $17.00/mg, $17.13/mg, and $14.07/mg, it would be cost-effective at a willingness to pay (WTP) threshold of $50,000/QALY in all HER2-low advanced BC patients, HER2+ advanced BC patients and HER2- advanced BC patients, respectively. At a WTP threshold of $100,000/QALY, the probability of T-DXd being cost-effective was 81.10%, 82.27%, and 73.78% compared to chemotherapy for all HER2-low advanced BC patients, HER2+ advanced BC patients and HER2- advanced BC patients, respectively. Most subgroups of patients with HER2+ disease had a cost-effectiveness probability of > 50%. <h4>Conclusion</h4> From a third-party payer’s perspective in the United States, the findings of the cost-effectiveness analysis revealed that, at the current price, T-DXd is a cost-effective alternative to chemotherapy for patients with prior HER2-low advanced BC, at WTP threshold of $100,000/QALY.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449172/?tool=EBI |
| spellingShingle | Demin Shi Xueyan Liang Yan Li Lingyuan Chen Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer PLoS ONE |
| title | Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer |
| title_full | Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer |
| title_fullStr | Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer |
| title_full_unstemmed | Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer |
| title_short | Cost-effectiveness of trastuzumab deruxtecan for previously treated HER2-low advanced breast cancer |
| title_sort | cost effectiveness of trastuzumab deruxtecan for previously treated her2 low advanced breast cancer |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449172/?tool=EBI |
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