Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
Department of Pharmacy, The First Affiliated Hospital of Wannan Medical College, Anhui, China.
J Cancer Res Clin Oncol. 2023 Dec;149(20):17933-17942. doi: 10.1007/s00432-023-05496-2. Epub 2023 Nov 14.
Trastuzumab deruxtecan (T-DXd) expressed substantial improvement in the progression-free survival and overall survival contrasted with trastuzumab emtansine (T-DM1) in patients with HER2-positive metastatic breast cancer (mBC), becoming the second-line standard of care, promisingly. We aim to estimate the cost-utility of T-DXd versus T-DM1 in HER2-positive mBC from the Chinese healthcare perspective.
A partitioned survival model was applied to examine the cost-utility of T-DXd versus T-DM1. Clinical patients and outcome data were sourced from the DESTINY-Breast 03 trial. Costs and utilities were sourced in Chinese setting. Total costs, quality-adjusted life months (QALMs), and an incremental cost-utility ratios (ICUR) were calculated for cost-utility analysis. The willingness-to-pay threshold was set at $3188/QALM. Univariate, scenario, and probabilistic sensitivity analyses were performed.
T-DXd group gained ∆QALM of 7.09 months and ∆Cost of $304,503 compared with T-DM1 therapy, which caused an ICUR of $42,936/QALM. The results of sensitivity analyses confirmed the base-case findings. Furthermore, T-DXd must reduce the price to enter the Chinese mainland market. At least when the cycle cost of T-DXd is reduced to $2975, T-DXd has an 83.3% chance of becoming a better choice.
T-DXd appears to be not cost effective compared with T-DM1 for HER2-positive mBC patients previously treated with trastuzumab and a taxane.
曲妥珠单抗-德鲁替康（T-DXd）在 HER2 阳性转移性乳腺癌（mBC）患者中的无进展生存期和总生存期与曲妥珠单抗-美坦新偶联物（T-DM1）相比有显著改善，成为二线治疗标准，前景看好。我们旨在从中国医疗保健角度评估 T-DXd 对比 T-DM1 在 HER2 阳性 mBC 中的成本效用。
采用分割生存模型评估 T-DXd 对比 T-DM1 的成本效用。临床患者和结局数据来源于 DESTINY-Breast 03 试验。成本和效用数据来源于中国情境。计算成本效用分析的总费用、质量调整生命月（QALM）和增量成本效用比（ICUR）。意愿支付阈值设定为 3188 美元/QALM。进行了单变量、情景和概率敏感性分析。
与 T-DM1 治疗相比，T-DXd 组获得了 7.09 个月的 QALM 增益和 304503 美元的增量成本，导致 ICUR 为 42936 美元/QALM。敏感性分析的结果证实了基础案例的发现。此外，T-DXd 必须降低价格才能进入中国大陆市场。至少当 T-DXd 的周期成本降低到 2975 美元时，T-DXd 才有 83.3%的可能性成为更好的选择。
与先前接受曲妥珠单抗和紫杉烷治疗的 HER2 阳性 mBC 患者相比，T-DXd 用于治疗 HER2 阳性 mBC 似乎不具有成本效益。
