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J Clin Oncol. 2016 Mar 20;34(9):902-9. doi: 10.1200/JCO.2015.62.9105. Epub 2015 Sep 8.

Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer.

Author information

1
Ben Y. Durkee, Yushen Qian, Erqi L. Pollom, Martin T. King, Sara A. Dudley, Jenny L. Shaffer, Daniel T. Chang, Iris C. Gibbs, and Kathleen C. Horst, Stanford University School of Medicine; and Jeremy D. Goldhaber-Fiebert, Stanford University, Stanford CA. bydurkee@stanford.edu.
2
Ben Y. Durkee, Yushen Qian, Erqi L. Pollom, Martin T. King, Sara A. Dudley, Jenny L. Shaffer, Daniel T. Chang, Iris C. Gibbs, and Kathleen C. Horst, Stanford University School of Medicine; and Jeremy D. Goldhaber-Fiebert, Stanford University, Stanford CA.

Abstract

PURPOSE:

The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab to docetaxel and trastuzumab (THP) as first-line treatment for patients with human epidermal growth factor receptor 2 (HER2) -overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of adding pertuzumab.

PATIENT AND METHODS:

We developed a decision-analytic Markov model to evaluate the cost effectiveness of docetaxel plus trastuzumab (TH) with or without pertuzumab in US patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in US dollars, and cost effectiveness expressed as an incremental cost-effectiveness ratio. One- and multiway deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions.

RESULTS:

Modeled median survival was 39.4 months for TH and 56.9 months for THP. The addition of pertuzumab resulted in an additional 1.81 life-years gained, or 0.62 QALYs, at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost effectiveness at a willingness to pay of $100,000 per QALY gained.

CONCLUSION:

THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States.

PMID:
26351332
PMCID:
PMC5070553
DOI:
10.1200/JCO.2015.62.9105
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

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