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Review
. 2017 Oct;165(3):485-498.
doi: 10.1007/s10549-017-4374-6. Epub 2017 Jul 8.

Reviewing the quality, health benefit and value for money of chemotherapy and targeted therapy for metastatic breast cancer

Xavier Ghislain Léon Victor Pouwels  1 , Bram L T Ramaekers  2 , Manuela A Joore  2
Affiliations
Review

Reviewing the quality, health benefit and value for money of chemotherapy and targeted therapy for metastatic breast cancer

Xavier Ghislain Léon Victor Pouwels et al. Breast Cancer Res Treat. 2017 Oct.

Abstract

Purpose: To provide an overview of model characteristics and outcomes of model-based economic evaluations concerning chemotherapy and targeted therapy (TT) for metastatic breast cancer (MBC); to assess the quality of the studies; to analyse the association between model characteristics and study quality and outcomes.

Methods: PubMED and NHS EED were systematically searched. Inclusion criteria were as follows: English or Dutch language, model-based economic evaluation, chemotherapy or TT as intervention, population diagnosed with MBC, published between 2000 and 2014, reporting life years (LY) or quality-adjusted life-year (QALY) and an incremental cost-effectiveness ratio. General characteristics, model characteristics and outcomes of the studies were extracted. Quality of the studies was assessed through a checklist.

Results: 24 studies were included, considering 50 comparisons (20 concerning chemotherapy and 30 TT). Seven comparisons were represented in multiple studies. A health state-transition model including the following health states: stable/progression-free disease, progression and death was used in 18 studies. Studies fulfilled on average 14 out of the 26 items of the quality checklist, mostly due to a lack of transparency in reporting. Thirty-one per cent of the incremental net monetary benefit was positive. TT led to higher iQALY gained, and industry-sponsored studies reported more favourable cost-effectiveness outcomes.

Conclusions: The development of a disease-specific reference model would improve the transparency and quality of model-based cost-effectiveness assessments for MBC treatments. Incremental health benefits increased over time, but were outweighed by the increased treatment costs. Consequently, increased health benefits led to lower value for money.

Keywords: Breast neoplasms; Cost-benefit analysis; Economic; Models; Neoplasm metastasis; Quality-adjusted life-years; Review.

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Conflict of interest statement

Conflict of interest statement

XP and BR declare that they have no conflict of interest. MJ has received a grant for the set-up of a Dutch breast cancer registry from the Netherlands Organisation for Health Research and Development (ZonMw, grant number: 80-82500-98-9056), Roche Netherlands and Eisai.

Statement on the welfare of animals/respect of human rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Figures

Fig. 1
Fig. 1
Consort diagram of the selection procedure. ABC advanced breast cancer, chemo chemotherapy, ICER incremental cost-effectiveness ratio, LY Life years, MBC metastatic breast cancer, QALY Quality-adjusted life years
Fig. 2
Fig. 2
Association between study quality and study characteristics and between study quality and outcomes. a Association between study quality and study sponsorship; b association between study quality and publication year; c association between study quality and iQALY; d association between study quality and iNMB; iQALY incremental quality-adjusted life-year; iNMB incremental net monetary benefit
Fig. 3
Fig. 3
Association between model characteristics and study outcomes. a Association between iQALY and publication year; b association between study iNMB and publication year; c association between iQALY and time horizon; d association between iNMB and time horizon; iQALY incremental quality-adjusted life-year; iNMB incremental net monetary benefit
Fig. 4
Fig. 4
Association between iQALYs and iNMBs. iQALY incremental quality-adjusted life-year; iNMB incremental net monetary benefit
See this image and copyright information in PMC

Comment in

  • Lazzaro responds to Pouwels et al.
    Lazzaro C. Lazzaro C. Breast Cancer Res Treat. 2021 Nov;190(1):1. doi: 10.1007/s10549-021-06347-9. Epub 2021 Aug 5. Breast Cancer Res Treat. 2021. PMID: 34355299 No abstract available.

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