Beauchemin C, Letarte N, Mathurin K, Yelle L, Lachaine J
a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada ;
b Département de pharmacie , Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame , Montreal , Quebec , Canada ;
J Med Econ. 2016 Jun;19(6):619-29. doi: 10.3111/13696998.2016.1151431. Epub 2016 Mar 2.
Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC. Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC. Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2 + MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations. Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.
目的 鉴于转移性乳腺癌（MBC）的治疗选择日益增多，开发高质量方法以评估新型抗癌药物的成本效益非常重要。本研究旨在构建一个全球经济模型，用作MBC新疗法经济评估的基准。方法 转移性乳腺癌全球药物经济学（GPMBC）模型是一个马尔可夫模型，构建该模型是为了从加拿大医疗保健系统的角度，在终身范围内估计MBC新疗法每质量调整生命年（QALY）的增量成本。该模型纳入的具体参数包括药物治疗成本、生存结果以及治疗相关不良事件（AE）的发生率。全局参数包括患者特征、健康状态效用、负效用以及与治疗相关AE相关的成本，以及与药物给药、医学随访和临终关怀相关的成本。通过评估拉帕替尼联合来曲唑与其他广泛使用的一线疗法治疗激素受体阳性（HR+）和表皮生长因子受体2阳性（HER2+）的绝经后MBC女性的成本效益，在特定背景下对GPMBC模型进行了测试和验证。结果 在进行测试时，GPMBC模型得出，拉帕替尼联合来曲唑与单独使用来曲唑、曲妥珠单抗联合阿那曲唑以及单独使用阿那曲唑相比，每QALY的增量成本效用比分别为131 811加元、56 211加元和102 477加元。模型测试结果与Delea等人获得的结果非常相似，Delea等人也在加拿大评估了拉帕替尼联合来曲唑治疗HR+/HER2+ MBC的成本效益，这表明GPMBC模型能够复制良好的经济评估结果。结论 GPMBC模型可能非常有价值，因为它能够在加拿大背景下快速有效地评估MBC任何新疗法的成本效益。
