title: Everolimus plus exemestane versus bevacizumab-based chemotherapy for second-line treatment of hormone receptor-positive metastatic breast cancer in Greece: An economic evaluation study.
abstract: BACKGROUND
  The objective of our study was to conduct a cost-effectiveness (CE) study of combined everolimus (EVE) and exemestane (EXE) versus the common clinical practice in Greece for the treatment of postmenopausal women with HR+/HER2- advanced breast cancer (BC) progressing on nonsteroidal aromatase inhibitors (NSAI). The combinations of bevacizumab (BEV) plus paclitaxel (PACL) and BEV plus capecitabine (CAPE) were selected as comparators.
  
  
  METHODS
  A Markov model, consisting of three health states, was used to describe disease progression and evaluate the CE of the comparators from a third-party payer perspective over a lifetime horizon. Efficacy and safety data as well as utility values considered in the model were extracted from the relevant randomized Phase III clinical trials and other published studies. Direct medical costs referring to the year 2014 were incorporated in the model. A probabilistic sensitivity analysis was conducted to account for uncertainty and variation in the parameters of the model. Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs), total direct costs and incremental cost-effectiveness ratios (ICER).
  
  
  RESULTS
  The discounted quality-adjusted survival of patients treated with EVE plus EXE was greater by 0.035 and 0.004 QALYs, compared to BEV plus PACL and BEV plus CAPE, respectively. EVE plus EXE was the least costly treatment in terms of drug acquisition, administration, and concomitant medications. The total lifetime cost per patient was estimated at €55,022, €67,980, and €62,822 for EVE plus EXE, BEV plus PACL, and BEV plus CAPE, respectively. The probabilistic analysis confirmed the deterministic results.
  
  
  CONCLUSIONS
  Our results suggest that EVE plus EXE may be a dominant alternative relative to BEV plus PACL and BEV plus CAPE for the treatment of HR+/HER2- advanced BC patients failing initial therapy with NSAIs.
authors.affiliation: The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. kurlaba@hua.gr.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kourlaba
authors.affiliation: HYGEIA Hospital, Maroussi, Greece. v.rapti@yahoo.gr.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Rapti
authors.affiliation: HYGEIA Hospital, Maroussi, Greece. a.alexo@yahoo.gr.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Alexopoulos
authors.affiliation: Department of Health Services Organization & Management, National School of Public Health, Athens, Greece. j_relakis@yahoo.gr.
authors.forename: John
authors.initials: J
authors.lastname: Relakis
authors.affiliation: 2nd Department of Pathology-Oncology, St. Savvas Hospital, Athens, Greece. gkoumak@otenet.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Koumakis
authors.affiliation: Novartis Hellas SA, Metamorphosis, Metamorfossi, Greece. magdalini.chatzikou@novartis.com.
authors.forename: Magdalini
authors.initials: M
authors.lastname: Chatzikou
authors.affiliation: Department of Health Services Organization & Management, National School of Public Health, Athens, Greece. nmaniadakis@esdy.edu.gr.
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
authors.affiliation: Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece. georgoul@med.uoc.gr.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Georgoulias
mesh_terms: D000730:Androstadienes / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics*; D000068258:Bevacizumab / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D000068338:Everolimus / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006115:Greece; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years
chemical_list: D000730:Androstadienes; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab; D000068338:Everolimus; C056516:exemestane