PAI (Policy Analysis Inc.), Brookline, MA, U.S.A.
Curr Oncol. 2013 Oct;20(5):e371-87. doi: 10.3747/co.20.1394.
The cost-effectiveness of first-line treatment with lapatinib plus letrozole for postmenopausal women with hormone receptor-positive (hr+), human epidermal growth factor receptor 2-positive (her2+) metastatic breast cancer (mbc) has not been assessed from the Canadian health care system and societal perspectives.
A partitioned survival analysis model with 3 health states (alive, pre-progression; alive, post-progression; dead) was developed to estimate direct and indirect costs and quality-adjusted life years (qalys) with lapatinib-letrozole, letrozole, anastrozole, or trastuzumab-anastrozole as first-line treatment. Clinical inputs for lapatinib-letrozole and letrozole were taken from the EGF30008 trial (NCT00073528). Clinical inputs for anastrozole and trastuzumab-anastrozole were taken from a network meta-analysis of published studies. Drug costs were obtained from the manufacturer's price list, the Quebec list of medications, and imsBrogan. Other costs were taken from the Ontario Health Insurance Plan's Schedule of Benefits and Fees and published studies. A 10-year time horizon was used. Costs and qalys were discounted at 5% annually. Deterministic and probabilistic sensitivity analyses were performed to assess the effects of changes in model parameters.
Quality-adjusted life years gained with lapatinib-letrozole were 0.236 compared with trastuzumab-anastrozole, 0.440 compared with letrozole, and 0.568 compared with anastrozole. Assuming a health care system perspective, incremental costs were $5,805, $67,029, and $67,472 respectively. Given a cost per qaly threshold of $100,000, the probability that lapatinib-letrozole is preferred was 21% compared with letrozole, 36% compared with anastrozole, and 68% compared with trastuzumab-anastrozole. Results from the societal perspective were similar.
In postmenopausal women with hr+/her2+ mbc receiving first-line treatment, lapatinib-letrozole may not be cost-effective compared with letrozole or anastrozole, but may be cost-effective compared with trastuzumab-anastrozole.
从加拿大医疗保健系统和社会角度来看，尚未评估用于治疗激素受体阳性（HR+）、人表皮生长因子受体 2 阳性（HER2+）转移性乳腺癌（MBC）绝经后妇女的一线治疗药物拉帕替尼加来曲唑的成本效益。
采用生存分析模型，将患者分为 3 种健康状态（存活、无进展前；存活、进展后；死亡），分别评估来曲唑、阿那曲唑、曲妥珠单抗-阿那曲唑、拉帕替尼-来曲唑作为一线治疗药物的直接和间接成本以及质量调整生命年（QALY）。拉帕替尼-来曲唑和来曲唑的临床数据来源于 EGF30008 试验（NCT00073528）。阿那曲唑和曲妥珠单抗-阿那曲唑的临床数据来源于已发表文献的网络荟萃分析。药物成本来自制造商的价格清单、魁北克药品清单和 imsBrogan。其他成本则来自安大略省健康保险计划的福利和费用表以及已发表的研究。采用 10 年时间范围。成本和 QALY 每年贴现 5%。通过对模型参数的变化进行确定性和概率敏感性分析，评估了这些变化对结果的影响。
与曲妥珠单抗-阿那曲唑相比，拉帕替尼-来曲唑可使 QALY 增加 0.236，与来曲唑相比可增加 0.440，与阿那曲唑相比可增加 0.568。从医疗保健系统角度来看，增量成本分别为 5805 美元、67029 美元和 67472 美元。假设成本-效果阈值为 10 万美元，与来曲唑相比，拉帕替尼-来曲唑的概率为 21%，与阿那曲唑相比的概率为 36%，与曲妥珠单抗-阿那曲唑相比的概率为 68%。从社会角度来看，结果相似。
在接受一线治疗的 HR+/HER2+MBC 绝经后妇女中，与来曲唑或阿那曲唑相比，拉帕替尼-来曲唑可能并不具有成本效益，但与曲妥珠单抗-阿那曲唑相比，拉帕替尼-来曲唑可能具有成本效益。
