title: Economic evaluation of eribulin as second-line treatment for metastatic breast cancer in South Korea.
abstract: BACKGROUND
  Metastatic breast cancer (MBC) is associated with poor prognosis, particularly for those patients with human epidermal growth factor receptor (HER2)-negative tumor. Similar to the rest of the world, treatment options are limited in South Korea following first-line chemotherapy with anthracyclines and/or taxanes. This study examined the cost-effectiveness and cost-utility of eribulin in South Korean patients with HER2-negative MBC who have progressed after usage of at least one chemotherapeutic regimen for advanced disease (second-line therapy).
  
  
  METHODS
  A partition survival model was developed from the perspective of the South Korean health care system. The economic impact of introducing eribulin as second-line therapy for HER2-negative MBC was compared to that of capecitabine and vinorelbine. The analysis estimated incremental cost per life-year (LY), that is, cost-effectiveness, and cost per quality-adjusted life-year (QALY), that is, cost-utility, of eribulin for management of HER2-negative MBC in South Korea. The model accounted for overall survival, progression-free survival, drug costs, grade 3/4 adverse events, and health care utilization. Deterministic and probabilistic sensitivity analyses were performed to identify uncertainty in the results of the economic evaluation.
  
  
  RESULTS
  Second-line eribulin was associated with greater benefits in terms of LY and QALY, compared to capecitabine and vinorelbine. The incremental cost-effectiveness ratio was ₩10.5M (approximately USD 9,200) per LY, and the incremental cost-utility ratio was ₩17M (approximately USD 14,800) per QALY in the basecase analysis. The incremental cost-utility ratio ranged from ₩12M (USD 10,461) to ₩27M (USD 23,538) per QALY in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, >99% of the simulations were below ₩50M (USD 42,300), and the lower and upper 95% confidence intervals were ₩3M (USD 2,600) and ₩24M (USD 20,900) per QALY, respectively.
  
  
  CONCLUSIONS
  There currently exist a limited number of treatment choices for women with HER2-negative MBC. Eribulin is a cost-effective option for second-line therapy in South Korea and should be added to the current indications for reimbursement.
authors.affiliation: Geneconomics Inc., Lévis, Quebec, Canada.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tremblay
authors.affiliation: Global Value and Access, Eisai Inc., Woodcliff Lake, NJ.
authors.forename: Unnati
authors.initials: U
authors.lastname: Majethia
authors.affiliation: Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
authors.forename: Janis L
authors.initials: JL
authors.lastname: Breeze
authors.affiliation: Global Value and Access, Eisai Limited, Hatfield, Hertfordshire, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Kontoudis
authors.affiliation: Eisai Korea Inc., Gangnam-gu, Seoul, South Korea.
authors.forename: Jeongae
authors.initials: J
authors.lastname: Park
keywords: cost-utility; economic analysis; eribulin; metastatic breast cancer