Fujian Medical University, School of Pharmacy, Fuzhou, Fujian, 350004, PR China; Shengli Clinical Medical College of Fujian Medical University, Fujian Province Hospital, Department of Pharmacy, Fuzhou, Fujian, 350001, PR China.
The First Hospital of Changsha City, Affiliated Changsha Hospital of XiangYa School of Medicine, CSU, Changsha, Hunan, 410000, PR China.
Breast. 2024 Apr;74:103680. doi: 10.1016/j.breast.2024.103680. Epub 2024 Feb 9.
Circulating tumor cell (CTC) counting may be a useful non-invasive biomarker that helps patients choose first-line treatment options. Nevertheless, the cost of CTC inspection may impose an economic burden on patients, necessitating the simultaneous consideration of both its clinical effectiveness and cost. We evaluated the cost-effectiveness of CTC count-guided chemotherapy and endocrine therapy as first-line therapy for HR+/HER2-metastatic breast cancer (MBC) from the perspective of US payers.
Based on the STIC CTC trial, a Markov model was constructed for three health states, and health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to assess the robustness of the incremental cost per QALY.
The base-case analysis revealed that CTC count-driven treatment was associated with improved effectiveness by 0.07 QALYs and increased the overall cost by $9187.05 compared with clinician-driven first-line treatment choices, leading to an ICER of $138 354.15 per QALY. One-way sensitivity analysis indicated that the model was most sensitive to the cost of treatment for neutropenia and the utility for PFS; probability sensitivity analysis indicated that CTC count-driven treatment choices would be considered the cost-effective option at a willingness-to-pay threshold of $150 000 per QALY.
The findings of this cost-effectiveness analysis suggest that, at the current price of CTC enumeration, choosing first-line treatment options based on CTC count is a cost-effectiveness approach for treating patients with HR+/HER2- MBC in the US.
循环肿瘤细胞（CTC）计数可能是一种有用的非侵入性生物标志物，可以帮助患者选择一线治疗方案。然而，CTC 检查的费用可能会给患者带来经济负担，因此需要同时考虑其临床效果和成本。我们从美国支付者的角度评估了 CTC 计数指导的化疗和内分泌治疗作为 HR+/HER2-转移性乳腺癌（MBC）一线治疗的成本效益。
基于 STIC CTC 试验，构建了一个三状态 Markov 模型，并用质量调整生命年（QALY）和增量成本效益比（ICER）来衡量健康结果。进行了单因素和概率敏感性分析，以评估增量成本每 QALY 的稳健性。
基于模型的分析显示，与临床医生驱动的一线治疗选择相比，CTC 计数驱动的治疗可使有效性提高 0.07 QALY，总费用增加 9187.05 美元，导致每 QALY 的 ICER 为 138354.15 美元。单因素敏感性分析表明，该模型对中性粒细胞减少症治疗费用和 PFS 效用最为敏感；概率敏感性分析表明，在每 QALY 150000 美元的支付意愿阈值下，基于 CTC 计数选择一线治疗方案将被认为是具有成本效益的选择。
这项成本效益分析的结果表明，在目前 CTC 计数的价格下，基于 CTC 计数选择一线治疗方案是治疗美国 HR+/HER2-MBC 患者的一种具有成本效益的方法。
