Title : Cost-effectiveness analysis of talazoparib maintenance treatment for patients with germline BRCA1/2 mutated HER2-negative advanced breast cancer
Abstract:
Objective:
For breast cancer with BRCA1/2 gene mutation, the PARP inhibitor talazoparib has been proven to have a tumor therapeutic effect and has shown good efficacy in phase III clinical trials. Based on the phase III EMBRACE trial ?NCT01945775?clinical trials, we evaluated for the first time the cost-effectiveness of maintenance talazoparib with HER2-negative advanced breast cancer. From the payer’s perspective of the US and China, a cost-effectiveness analysis was conducted to evaluate the costs and benefits of adding talazoparib in this study.
Methods:
A Markov model was developed using the phase 3 EMBRACA clinical trials (Clinical Trails.gov number, NCT01945775) to evaluate the cost-effectiveness of talazoparib and the physician’s choice of chemotherapy. We constructed a Markov model for the economic evaluation of patients who received talazoparib or the physician’s choice of chemotherapy. The state transition probabilities and clinical data were extracted from the phase 3 EMBRACA clinical trials. The cost data were estimated from local pricing, the relevant literature, and expert consultancy. The health outcomes are expressed by quality-adjusted life years (QALYs). All costs and incremental cost-effectiveness ratios (ICERs) are presented in US dollars. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis were performed to assess the uncertainty of the models. The model was conducted with a 5-year time horizon, and the health status was divided into three states: progression-free survival, progressing disease, and death. The health utility scores were consistent with published literature with similar patient status. The unit prices of medicines were obtained from the West China Hospital, Red Book, and published literature. Outcomes were measured in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio, which robustness was evaluated by deterministic and probabilistic sensitivity analyses.
Results:
Based on the Chinese Markov model, the base case ICER for talazoparib versus the control group, with incremental costs of $2484.48/QALY and an incremental QALY of 1.5, indicating that it was cost-effective from the aspect of the Chinese healthcare system. However, as shown by the American Markov model,talazoparib was dominant versus the control group, with a cost saving of $10223.43 and a gain of 1.5 QALYs.One-way deterministic sensitivity analyses showed that the economic benefits generated by the use of talazoparib as a treatment strategy in both China and the US are much greater.
Conclusion:
Talazoparib was estimated to be more cost-effective than the maintenance therapy of patients with germline BRCA1/2 mutated HER2-negative advanced breast cancer in China and the US at thresholds of $3185/month and $19100/month per QALY, respectively.
Audience Take Away:
- This study evaluates the cost-effectiveness of talazoparib vs. the physician’s choice of chemotherapy as maintenance therapy for germline BRCA1/2 mutated HER2-negative advanced breast cancer from the perspective of healthcare in China and the US. The results provide a reference for the selection of safer, more effective, and cost-efficient clinical treatment options for patients with BRCA mutation and metastatic breast cancer in these two countries.
- Through reviewing relevant literature, we found that there was a lack of economic research on the use of Talazoparib in the treatment of BRCA1/2 mutant advanced breast cancer patients. The analysis of this article is based on the medical and health systems of China and the US and includes the cost considerations of drug treatment, hospital care, auxiliary examinations, and treatment of adverse reactions. Through the analysis of the economic development situation of China and the US, the economic capacity and willingness to pay off the people of both countries are understood, and the relevant information compiled is relatively comprehensive.
- Other faculty could use this research to expand their research.
- It Will improve the accuracy of a design, or provide new information to assist in a design problem.
