title: Estimated Life-Years Saved in Women with HER2-Positive Metastatic Breast Cancer Receiving First-Line Trastuzumab and Pertuzumab in the United States.
abstract: BACKGROUND
  HER2 positive (HER2+) metastatic breast cancer (MBC) is associated with high mortality. Trastuzumab was approved for use in 1998, but the life-years saved from first-line use are unknown, as are the potential US population benefits from adding pertuzumab.
  
  
  OBJECTIVE
  The first aim was to estimate the number of life-years saved by using first-line trastuzumab between 1999 and 2013 in HER2+ women with MBC. In addition, based on these estimates, the second aim was to project the life-years that could be saved by adding pertuzumab to trastuzumab in first-line therapy.
  
  
  METHODS
  We constructed a simulation model accounting for incidence, testing rates, therapy utilization, and overall survival. The model was run for 1999 to 2013 (15 years) to estimate the life-years saved from using trastuzumab plus chemotherapy instead of chemotherapy alone. The model was also run from 2013 to 2027 (15 years) to project the life-years that might be saved by adding pertuzumab. Uncertainty was incorporated using Monte-Carlo methods.
  
  
  RESULTS
  The estimated number of women with HER2+ MBC varied over time, with the peak of 9700 in 2005 and the low of 7700 in 2018. The cumulative incremental life-years saved because of first-line trastuzumab use from 1999 to 2013 was estimated to be 156,413 (95% simulation interval 114,840-195,201). The projection for pertuzumab from 2013 to 2027 was 137,959 (95% simulation interval 56,011-225,069). Exploratory analyses of value showed that pertuzumab, trastuzumab, and chemotherapy is associated with a $1.10 billion gain compared with chemotherapy alone, and adding pertuzumab is associated with a $0.06 billion gain compared with trastuzumab with chemotherapy.
  
  
  CONCLUSIONS
  This simulation model suggests that substantial progress has been made in treating HER2+ women over the past 15 years, and the future may witness similar gains with the introduction of pertuzumab.
authors.affiliation: Outcomes Insights, Inc., Westlake Village, CA, USA. Electronic address: mark@outins.com.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Danese
authors.affiliation: Genentech, Inc, South San Francisco, CA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Masaquel
authors.affiliation: Genentech, Inc, South San Francisco, CA, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Santos
authors.affiliation: Genentech, Inc, South San Francisco, CA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Brammer
authors.affiliation: Outcomes Insights, Inc., Westlake Village, CA, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Lee
authors.affiliation: Palo Alto Outcomes Research, Palo Alto, CA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Lalla
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis / Q000037:antagonists & inhibitors*; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D018803:Models, Economic; D015233:Models, Statistical; D058990:Molecular Targeted Therapy; D009010:Monte Carlo Method; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis / Q000037:antagonists & inhibitors*; D013997:Time Factors; D000068878:Trastuzumab / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D035501:Uncertainty; D014481:United States / Q000453:epidemiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014408:Biomarkers, Tumor; D047428:Protein Kinase Inhibitors; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human; C485206:pertuzumab
keywords: breast cancer; epidemiology; life-years; pertuzumab; trastuzumab