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. 2022 May 6:20:eGS6655.
doi: 10.31744/einstein_journal/2022GS6655. eCollection 2022.

Cost-effectiveness analysis of Ado-trastuzumab emtansine for the treatment of residual invasive HER2-positive breast cancer

Marcos Aurélio Fonseca Magalhães Filho  1 , Pedro Nazareth Aguiar Jr  1 , Milena Brachmans Mascarenhas Neves  1 , Gilberto de Lima Lopes Jr  2 , Auro Del Giglio  1
Affiliations

Cost-effectiveness analysis of Ado-trastuzumab emtansine for the treatment of residual invasive HER2-positive breast cancer

Marcos Aurélio Fonseca Magalhães Filho et al. Einstein (Sao Paulo). .

Abstract

Objective: Human epidermal growth factor receptor 2 (HER2) overexpression occurs in up to 30% of breast cancer cases. Ado-trastuzumab emtansine (T-DM1) is approved to treat residual HER2-positive breast cancer after neoadjuvant therapy. The aim of this study was to determine the quality-adjusted time with symptoms or toxicity and without symptoms or toxicity (Q-TWiST) of T-DM1 compared to trastuzumab for residual invasive HER2-positive breast cancer.

Methods: The authors developed an analytical model extracting individual patient data and estimated invasive disease-free survival and overall survival over a 30-year time horizon. Only direct costs from adjuvant treatment were considered as well as relapse treatment from Brazilian and American payer perspectives. Heart events were considered for utility and cost analysis.

Results: The 30-year projection utilizing the Weibull method estimated a mean invasive disease-free survival of 16.4 years for T-DM1 and 10.4 for Trastuzumab, in addition to a mean overall survival of 18.1 and 15.4 years, respectively. We determined a Q-TWiST gain of 3,812 years for the T-DM1 arm when compared to trastuzumab and an Incremental cost-effectiveness ratio per Q-TWiST of US$ 11,467.65 in the United States and US$ 3,332.73 in Brazil.

Conclusion: Ado-trastuzumab emtansine is cost-effective from both Brazilian and American perspectives.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. Decision-analytic model
Figure 2
Figure 2. Kaplan-Meier with Weibull overall survival
Figure 3
Figure 3. Kaplan-Meier with Weibull invasive disease-free survival
Figure 4
Figure 4. Deterministic sensitivity analysis
See this image and copyright information in PMC

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