title: Cost-Effectiveness of Lapatinib plus Letrozole in Post-Menopausal Women with Hormone Receptor-and HER2-Positive Metastatic Breast Cancer.
abstract: BACKGROUND
  In the EGF30008 and TAnDEM (TrAstuzumab in Dual HER2 ER-positive Metastatic breast cancer) trials, anti-HER2 therapy plus an aromatase inhibitor (lapatinib + letrozole (LAP + LET) and trastuzumb + anastrozole (TZ + ANA), respectively) improved time to progression versus aromatase inhibitor monotherapy (LET and ANA, respectively) in post-menopausal women with previously untreated hormone receptor-positive (HR+) and HER2-positive (HER2+) metastatic breast cancer.
  
  
  METHODS
  A partitionedsurvival analysis model using data from EGF30008 and published results of TAnDEM and other literature was used to evaluate the incremental direct medical cost per quality-adjusted life year (QALY) gained with LAP + LET versus LET, ANA, and TZ + ANA in post-menopausal women with previously untreated HR+ and HER2+ metastatic breast cancer from the UK National Health Service (NHS) perspective.
  
  
  RESULTS
  Incremental costs for LAP + LET are £ 34,737 versus LET, £ 35,995 versus ANA, and £ 5,513 versus TZ + ANA. Corresponding QALYs gained are 0.467, 0.601, and 0.252 years. Cost/QALY gained with LAP + LET is £ 74,448 versus LET, £ 59,895 versus ANA, and £ 21,836 versus TZ + ANA. Given a threshold of £ 30,000/QALY, the estimated probability that LAP + LET is cost-effective is 1.4% versus LET, 9.2% versus ANA, and 51% versus TZ + ANA.
  
  
  CONCLUSIONS
  Based on criteria for the evaluation of health technologies in the UK (£ 30,000/QALY), LAP + LET is not likely to be cost-effective versus aromatase inhibitor monotherapy but may be cost-effective versus TZ + ANA, although the latter comparison is associated with substantial uncertainty.
authors.affiliation: Policy Analysis Inc. (PAI), Brookline, MA, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.affiliation: GlaxoSmithKline, Uxbridge, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Hawkes
authors.affiliation: GlaxoSmithKline, Collegeville, PA, USA.
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Amonkar
authors.affiliation: GlaxoSmithKline, GSK House, Brentford, London, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Lykopoulos
authors.affiliation: Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK.
authors.forename: Stephen R D
authors.initials: SR
authors.lastname: Johnston
keywords: Aromatase inhibitors; Breast cancer; Combination therapy; Costs; HER2; Hormonal treatment; Lapatinib; Metastatic disease; Trastuzumab