Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
West China School of Pharmacy, Sichuan University, Chengdu, China.
Front Public Health. 2023 Jun 30;11:1049947. doi: 10.3389/fpubh.2023.1049947. eCollection 2023.
Breast cancer is a rapidly raising healthcare problem worldwide. DESTINY-Breast04 demonstrated that trastuzumab deruxtecan (T-Dxd) had a survival advantage comparing to the physician's choice of chemotherapy for patients with HER2-low metastatic breast cancer. But at the same time, this expensive novel treatment also brought an economic burden. This study assessed the cost-effectiveness of T-Dxd based on results of DESTINY-Breast04 from the perspective of Chinese healthcare system.
A three-state partitioned-survival model [progression-free survival (PFS), progressive disease (PD) and death] based on data from DESTINY-Breast04 and Chinese healthcare system was used to estimate the incremental cost-effectiveness ratio (ICER) of T-Dxd vs. the physician's choice of chemotherapy for HER2-low metastatic breast cancer. Costs, quality-adjusted life-years (QALYs) and the ICER in terms of 2022 US$ per QALY gained were calculated for both hormone receptor-positive cohort and all patients. One-way and probabilistic sensitivity analyses were performed to assess the model robustness.
Compared with the physician's choice of chemotherapy, T-Dxd increased costs by $104,168.30, while gaining 0.31 QALYs, resulting in an ICER of $336,026.77 per QALY in all patients. The costs of T-Dxd and the utility of PFS were the crucial factors in determining the ICER. In the hormone receptor-positive cohort, the ICER was lower than that in all patients, with the ICER of $274,905.72 per QALY. The ICER was much higher than the commonly accepted willingness-to-pay threshold ($357,96.83 per QALY).
T-Dxd as second- or subsequent-line treatment is not a cost-effective treatment option for HER2-low metastatic breast cancer from the perspective of the Chinese healthcare system.
乳腺癌是全球范围内迅速上升的医疗保健问题。DESTINY-Breast04 研究表明，对于人表皮生长因子受体 2（HER2）低转移性乳腺癌患者，与医生选择的化疗相比，曲妥珠单抗-德鲁替康（T-Dxd）具有生存优势。但与此同时，这种昂贵的新型治疗方法也带来了经济负担。本研究从中国医疗保健系统的角度，基于 DESTINY-Breast04 的研究结果，评估 T-Dxd 的成本效益。
基于 DESTINY-Breast04 数据和中国医疗保健系统，采用三状态分区生存模型（无进展生存期[PFS]、疾病进展[PD]和死亡）来估计 T-Dxd 与医生选择的化疗用于 HER2 低转移性乳腺癌的增量成本效益比（ICER）。分别计算了 T-Dxd 对比医生选择的化疗在激素受体阳性患者和所有患者中每增加一个质量调整生命年（QALY）的成本、成本效益比（ICER）和以 2022 年美元计算的每 QALY 增量成本。进行了单因素和概率敏感性分析以评估模型的稳健性。
与医生选择的化疗相比，T-Dxd 增加了 104168.30 美元的成本，同时获得了 0.31 个 QALY，导致所有患者的 ICER 为 336026.77 美元/QALY。T-Dxd 的成本和 PFS 的效用是决定 ICER 的关键因素。在激素受体阳性患者中，ICER 低于所有患者，为 274905.72 美元/QALY。ICER 远高于普遍接受的支付意愿阈值（357968.30 美元/QALY）。
从中国医疗保健系统的角度来看，T-Dxd 作为二线或后续线治疗，对于 HER2 低转移性乳腺癌并非一种具有成本效益的治疗选择。
