Sabale Ugne, Ekman Mattias, Thunström Daniel, Telford Claire, Livings Christopher
Department of Health Economics, AstraZeneca Nordic-Baltic, 151 85, Södertälje, Sweden.
AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA.
Pharmacoecon Open. 2017 Dec;1(4):279-290. doi: 10.1007/s41669-017-0031-6.
In Sweden, breast cancer (BC) represents 30% of newly diagnosed cancers and is the most common cancer in women. For hormone-dependent BC, endocrine therapies varying in efficacy and price are available. The aim of this study is to assess the cost effectiveness of fulvestrant 500 mg as a second-line hormonal therapy for postmenopausal women with estrogen receptor-positive metastatic or locally advanced BC versus letrozole, anastrozole, and exemestane in Sweden.
A three-state (pre-progression, post-progression, and death) partitioned-survival model was used to estimate progression-free (PFS) and overall survival (OS) by extrapolating trial results beyond the trial period to capture costs and benefits over a lifetime perspective. The comparative effectiveness was sourced from a network meta-analysis. The evaluation was conducted from a Swedish national payer perspective; costs, resource use, and quality of life were based on published sources and expert opinion.
Compared to anastrozole, letrozole, and exemestane the incremental cost-effectiveness ratios (ICERs) were €33,808, €33,883, and €49,225 per QALY with incremental costs of €13,283, €14,986, and €13,862, and incremental QALYs of 0.393, 0.442, and 0.282, respectively. Incremental cost per life-year (LY) gained €21,312 (incremental LY of 0.623), €20,338 (incremental LY of 0.737), and €27,854 (incremental LY of 0.498) for respective comparators. Applying the upper and lower credible intervals for PFS/OS from the meta-analysis had the greatest effect on the ICER in the sensitivity analysis. The results were relatively stable when varying other parameters.
Our results indicate that fulvestrant 500 mg may be a cost-effective alternative to aromatase inhibitors at a threshold of €100,000/QALY.
在瑞典，乳腺癌（BC）占新诊断癌症的30%，是女性中最常见的癌症。对于激素依赖性乳腺癌，有疗效和价格各异的内分泌疗法。本研究的目的是评估500毫克氟维司群作为绝经后雌激素受体阳性转移性或局部晚期乳腺癌女性二线激素疗法相对于来曲唑、阿那曲唑和依西美坦在瑞典的成本效益。
采用三状态（进展前、进展后和死亡）分区生存模型，通过将试验结果外推至试验期以外来估计无进展生存期（PFS）和总生存期（OS），以从终身角度获取成本和效益。比较疗效源自网络荟萃分析。评估从瑞典国家支付方的角度进行；成本、资源使用和生活质量基于已发表的资料和专家意见。
与阿那曲唑、来曲唑和依西美坦相比，每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）分别为33,808欧元、33,883欧元和49,225欧元，增量成本分别为13,283欧元、14,986欧元和13,862欧元，增量QALY分别为0.393、0.442和0.282。各比较组每获得一个生命年（LY）的增量成本分别为21,312欧元（增量LY为0.623）、20,338欧元（增量LY为0.737）和27,854欧元（增量LY为0.498）。在敏感性分析中，应用荟萃分析中PFS/OS的上下可信区间对ICER影响最大。改变其他参数时，结果相对稳定。
我们的结果表明，在每QALY 100,000欧元的阈值下，500毫克氟维司群可能是芳香化酶抑制剂具有成本效益的替代方案。
