title: A global economic model to assess the cost-effectiveness of new treatments for advanced breast cancer in Canada.
abstract: Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC. Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC. Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2 + MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations. Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.
authors: a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada ;
authors: C
authors: C
authors: Beauchemin
authors: a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada ;|b Département de pharmacie , Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame , Montreal , Quebec , Canada ;
authors: N
authors: N
authors: Letarte
authors: a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada ;
authors: K
authors: K
authors: Mathurin
authors: c Département de médecine , Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame , Montreal , Quebec , Canada.
authors: L
authors: L
authors: Yelle
authors: a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada ;
authors: J
authors: J
authors: Lachaine
mesh_terms: D000077384:Anastrozole; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002170:Canada; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D000077341:Lapatinib; D000077289:Letrozole; D008390:Markov Chains; D017059:Models, Econometric; D009362:Neoplasm Metastasis; D009570:Nitriles / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis; D011960:Receptors, Estrogen / Q000096:biosynthesis; D011980:Receptors, Progesterone / Q000096:biosynthesis; D013727:Terminal Care / Q000191:economics; D000068878:Trastuzumab / Q000191:economics / Q000627:therapeutic use; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use
chemical_list: D000077384:Anastrozole; D000970:Antineoplastic Agents; D000077341:Lapatinib; D000077289:Letrozole; D009570:Nitriles; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D000068878:Trastuzumab; D014230:Triazoles; C508053:ERBB2 protein, human
keywords: Advanced breast cancer; Cost-effectiveness; Cost-utility; Markov model