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


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.


CONCLUSIONS
THP in patients with metastatic HER2-positive breast cancer is unlikely to be cost effective in the United States.
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.
Ben Y
BY
Durkee
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.
Yushen
Y
Qian
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.
Erqi L
EL
Pollom
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.
Martin T
MT
King
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.
Sara A
SA
Dudley
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.
Jenny L
JL
Shaffer
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.
Daniel T
DT
Chang
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.
Iris C
IC
Gibbs
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.
Jeremy D
JD
Goldhaber-Fiebert
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.
Kathleen C
KC
Horst
D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000191:economics*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000201:enzymology / Q000473:pathology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009361:Neoplasm Invasiveness; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics; D000068878:Trastuzumab / Q000008:administration & dosage / Q000191:economics; D014481:United States
D061067:Antibodies, Monoclonal, Humanized; D000077143:Docetaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C508053:ERBB2 protein, human; C485206:pertuzumab