Cost-Effectiveness Analysis of Trastuzumab Deruxtecan vs. Trastuzumab Emtansine for Patients with HER2+ Metastatic Breast Cancer in the United States.

Abstract

OBJECTIVE:

To assess the cost-effectiveness of trastuzumab deruxtecan compared to trastuzumab emtansine as second-line therapy for patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer from a US healthcare sector perspective.

METHODS:

A three-state partitioned survival model was developed to estimate the cost-effectiveness of trastuzumab deruxtecan compared to trastuzumab emtansine. For both treatments, modeled patients were administered treatment intravenously every three weeks indefinitely or until disease progression. Transition parameters were principally derived from the updated DESTINY-Breast03 phase III randomized clinical trial. Costs include drug costs extracted from CMS Average Sales Price and administrative, adverse event, and third-line therapy costs derived from published literature, measured in 2022 US Dollars. Health utilities for health states and disutilities for adverse events were sourced from published literature. Effects were measured in quality-adjusted life-years (QALYs). We conducted both probabilistic sensitivity analysis and comprehensive scenario analysis to test model assumptions and robustness, while utilizing a lifetime horizon.

RESULTS:

In our base-case analysis, total costs for trastuzumab deruxtecan were $1,266,945, compared to $820,082 for trastuzumab emtansine. Total QALYs for trastuzumab deruxtecan were 5.09, compared to 3.15 for trastuzumab emtansine. The base-case ICER was $230,285/QALY. Probabilistic sensitivity analysis indicated that trastuzumab deruxtecan had an 11.1% probability of being cost-effective at a $100,000 per QALY willingness-to-pay (WTP) threshold.

CONCLUSION:

Despite the higher efficacy of trastuzumab deruxtecan in patients with HER2+ metastatic breast cancer, our findings raise concern regarding its value at current prices.

• Authors: Rahul Mudumba, Hui-Hsuan Chan, Yuan-Yuan Cheng, Chien-Chen Wang, Luis Correia, Jeromie Ballreich, Joseph Levy
• Journal: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research (Value Health) (Nov 30 2023) ISSN: 1524-4733 [Electronic] United States
• PMID: 38042333 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. All rights reserved.