Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States?
Background: Circulating tumor cell (CTC) counting may be a useful non-invasive biomarker that helps patients choose first-line treatment options. Nevertheless, the cost of CTC inspection may impose an economic burden on patients, necessitating the simultaneous consideration of both its clinical effe...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977624000110 |
| _version_ | 1827310821730942976 |
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| author | Huiting Lin Wenhua Wu Xiaoya Lou Yiming Wang Hong Sun Jiaqin Cai Suyan Liu Xiaoxia Wei |
| author_facet | Huiting Lin Wenhua Wu Xiaoya Lou Yiming Wang Hong Sun Jiaqin Cai Suyan Liu Xiaoxia Wei |
| author_sort | Huiting Lin |
| collection | DOAJ |
| description | Background: Circulating tumor cell (CTC) counting may be a useful non-invasive biomarker that helps patients choose first-line treatment options. Nevertheless, the cost of CTC inspection may impose an economic burden on patients, necessitating the simultaneous consideration of both its clinical effectiveness and cost. We evaluated the cost-effectiveness of CTC count-guided chemotherapy and endocrine therapy as first-line therapy for HR+/HER2-metastatic breast cancer (MBC) from the perspective of US payers. Methods: Based on the STIC CTC trial, a Markov model was constructed for three health states, and health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the incremental cost per QALY. Results: The base-case analysis revealed that CTC count-driven treatment was associated with improved effectiveness by 0.07 QALYs and increased the overall cost by $9187.05 compared with clinician-driven first-line treatment choices, leading to an ICER of $138 354.15 per QALY. One-way sensitivity analysis indicated that the model was most sensitive to the cost of treatment for neutropenia and the utility for PFS; probability sensitivity analysis indicated that CTC count-driven treatment choices would be considered the cost-effective option at a willingness-to-pay threshold of $150 000 per QALY. Conclusions: The findings of this cost-effectiveness analysis suggest that, at the current price of CTC enumeration, choosing first-line treatment options based on CTC count is a cost-effectiveness approach for treating patients with HR+/HER2- MBC in the US. |
| first_indexed | 2024-03-08T00:24:20Z |
| format | Article |
| id | doaj.art-e80d477560374b6bb95f5d890d62692b |
| institution | Directory Open Access Journal |
| issn | 1532-3080 |
| language | English |
| last_indexed | 2024-04-24T20:07:14Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj.art-e80d477560374b6bb95f5d890d62692b2024-03-24T06:56:31ZengElsevierBreast1532-30802024-04-0174103680Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States?Huiting Lin0Wenhua Wu1Xiaoya Lou2Yiming Wang3Hong Sun4Jiaqin Cai5Suyan Liu6Xiaoxia Wei7Fujian Medical University, School of Pharmacy, Fuzhou, Fujian, 350004, PR China; Shengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR ChinaFujian Medical University, School of Pharmacy, Fuzhou, Fujian, 350004, PR China; Shengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR ChinaThe First Hospital of Changsha City, Affiliated Changsha Hospital of XiangYa School of Medicine, CSU, Changsha, Hunan, 410000, PR ChinaShengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR China; Fujian University of Traditional Chinese Medicine, School of Pharmacy, Fuzhou, Fujian, 350122, PR ChinaShengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR ChinaShengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR ChinaShengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR China; Fujian University of Traditional Chinese Medicine, School of Pharmacy, Fuzhou, Fujian, 350122, PR ChinaShengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR China; Corresponding author. Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, 350001, PR China.Background: Circulating tumor cell (CTC) counting may be a useful non-invasive biomarker that helps patients choose first-line treatment options. Nevertheless, the cost of CTC inspection may impose an economic burden on patients, necessitating the simultaneous consideration of both its clinical effectiveness and cost. We evaluated the cost-effectiveness of CTC count-guided chemotherapy and endocrine therapy as first-line therapy for HR+/HER2-metastatic breast cancer (MBC) from the perspective of US payers. Methods: Based on the STIC CTC trial, a Markov model was constructed for three health states, and health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the incremental cost per QALY. Results: The base-case analysis revealed that CTC count-driven treatment was associated with improved effectiveness by 0.07 QALYs and increased the overall cost by $9187.05 compared with clinician-driven first-line treatment choices, leading to an ICER of $138 354.15 per QALY. One-way sensitivity analysis indicated that the model was most sensitive to the cost of treatment for neutropenia and the utility for PFS; probability sensitivity analysis indicated that CTC count-driven treatment choices would be considered the cost-effective option at a willingness-to-pay threshold of $150 000 per QALY. Conclusions: The findings of this cost-effectiveness analysis suggest that, at the current price of CTC enumeration, choosing first-line treatment options based on CTC count is a cost-effectiveness approach for treating patients with HR+/HER2- MBC in the US.http://www.sciencedirect.com/science/article/pii/S0960977624000110Circulating tumor cellCost-effectiveness analysisBreast cancerMarkov model |
| spellingShingle | Huiting Lin Wenhua Wu Xiaoya Lou Yiming Wang Hong Sun Jiaqin Cai Suyan Liu Xiaoxia Wei Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? Breast Circulating tumor cell Cost-effectiveness analysis Breast cancer Markov model |
| title | Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? |
| title_full | Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? |
| title_fullStr | Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? |
| title_full_unstemmed | Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? |
| title_short | Is circulating tumor cell count-driven cost-effective for first-line therapy choice in HR+/HER2- metastatic breast cancer in the United States? |
| title_sort | is circulating tumor cell count driven cost effective for first line therapy choice in hr her2 metastatic breast cancer in the united states |
| topic | Circulating tumor cell Cost-effectiveness analysis Breast cancer Markov model |
| url | http://www.sciencedirect.com/science/article/pii/S0960977624000110 |
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