title: Economic Evaluations of Everolimus Versus Other Hormonal Therapies in the Treatment of HR+/HER2- Advanced Breast Cancer From a US Payer Perspective.
abstract: BACKGROUND
  The objective of the study was to assess the cost-effectiveness of EVE+EXE versus endocrine monotherapies in the treatment of postmenopausal women with HR(+), HER2(-) ABC after failure of treatment with nonsteroidal aromatase inhibitors from a US third-party payer perspective.
  
  
  METHODS
  A Markov model was developed to evaluate the costs and effectiveness associated with EVE+EXE, exemestane (EXE), fulvestrant (FUL), and tamoxifen (TAM) over a 10-year time horizon. The model included 3 health states: responsive/stable disease, progression, or death. Monthly transition probabilities were estimated based on the BOLERO-2 (Breast cancer trials of OraL EveROlimus-2) data and network meta-analyses. Costs included drug acquisition and administration costs, medical costs associated health states, and costs for managing adverse events (AEs). Utilities for each health state and disutilities for AEs were derived from the literature. Incremental costs per quality-adjusted life year (QALY) were estimated by comparing EVE+EXE with each endocrine monotherapy. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  In the base case, EVE+EXE was associated with 1.99 QALYs and total direct costs of $258,648 over 10 years. The incremental cost per QALY of EVE+EXE was $139,740 compared with EXE, $157,749 compared with FUL, and $115,624 compared with TAM. At a willingness-to-pay threshold of $130,000/QALY or above, EVE+EXE appeared to be the most cost-effective treatment among all drugs.
  
  
  CONCLUSIONS
  Everolimus with EXE demonstrated QALY improvements compared with 3 other endocrine monotherapies. Benchmarked by the economic value of other novel cancer therapies, EVE+EXE might be considered a cost-effective option compared with endocrine therapies for HR(+)/HER2(-) ABC.
authors.affiliation: Analysis Group, Inc, New York, NY. Electronic address: Jipan.Xie@analysisgroup.com.
authors.forename: Jipan
authors.initials: J
authors.lastname: Xie
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Analysis Group, Inc, Boston, MA.
authors.forename: Zheng-Yi
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: Analysis Group, Inc, Boston, MA.
authors.forename: Cynthia Z
authors.initials: CZ
authors.lastname: Qi
authors.affiliation: Analysis Group, Inc, New York, NY.
authors.forename: Gourab
authors.initials: G
authors.lastname: De
authors.affiliation: University of Miami, Miami, FL.
authors.forename: Stefan
authors.initials: S
authors.lastname: Glück
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000378:metabolism* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D000068338:Everolimus / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen
keywords: Cost-effectiveness analysis; Endocrine therapy; Markov model; Quality adjusted life year; Targeted therapy