Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for <italic style="font-style: italic">HER2</italic>-positive metastatic breast cancer

WU Yanan; WU Fang; HOU Yanhong

doi:10.6039/j.issn.1001-0408.2024.02.14

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Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer

更新时间：2025-09-25

- Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer
- ZHONGGUO YAOFANG Vol. 35, Issue 2, Pages: 204-209(2024)
- 作者机构：
  
  中国药科大学国际医药商学院，南京　211198
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.02.14
  CLC： R956;R979.1
- Received：29 July 2023，
  
  Revised：2023-12-25，
  
  Accepted：29 December 2023，
  
  Published：30 January 2024
- 稿件说明：
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武亚楠,吴方,侯艳红.德曲妥珠单抗对比恩美曲妥珠单抗二线治疗HER2阳性转移性乳腺癌的成本-效用分析[J].中国药房,2024,35(02):204-209.

WU Yanan,WU Fang,HOU Yanhong.Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer[J].ZHONGGUO YAOFANG,2024,35(02):204-209.
武亚楠,吴方,侯艳红.德曲妥珠单抗对比恩美曲妥珠单抗二线治疗HER2阳性转移性乳腺癌的成本-效用分析[J].中国药房,2024,35(02):204-209. DOI： 10.6039/j.issn.1001-0408.2024.02.14.

WU Yanan,WU Fang,HOU Yanhong.Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer[J].ZHONGGUO YAOFANG,2024,35(02):204-209. DOI： 10.6039/j.issn.1001-0408.2024.02.14.

摘要

目的

评估德曲妥珠单抗（T-DXd）对比恩美曲妥珠单抗（T-DM1）二线治疗

HER2

阳性转移性乳腺癌的经济性，为临床用药方案的选择及医疗卫生决策提供依据。

方法

基于DESTINY-Breast03试验构建分区生存模型，以3周为循环周期，模拟至患者终身。以质量调整生命年（QALY）作为产出指标并计算增量成本-效果比（ICER），再利用敏感性分析验证基础分析结果的稳健性，以此来比较T-DXd与T-DM1二线治疗

HER2

阳性转移性乳腺癌的经济性。

结果

在以3倍我国2022年人均国内生产总值（GDP）为意愿支付阈值（257 094元/QALY）的前提下，使用T-DXd方案的患者在获得增量效用（0.69 QALYs）的同时也需要支付更多成本，ICER值为1 850 478.40元/QALY。单因素敏感性分析结果显示，对ICER影响较大的因素有无进展生存期状态效用值、T-DXd价格、成本贴现率等，但这些参数在合理范围内波动均不能使基础分析结果发生翻转。概率敏感性分析结果显示，当WTP的阈值上升为1 500 400元/QALY时，T-DXd方案具有经济性的概率为50%。情境分析结果也验证了基础分析结果的稳健性。

结论

在以3倍我国人均GDP为意愿支付阈值的前提下，与T-DM1方案相比，T-DXd二线治疗

HER2

阳性转移性乳腺癌不具有经济性。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of trastuzumab deruxtecan（T-DXd） versus trastuzumab emtansine （T-DM1） in the second-line treatment of

HER2

-positive metastatic breast cancer， and to provide a basis for the selection of clinical medication regimen and medical and health decisions.

METHODS

Based on the clinical trial DESTINY-Breast03， a partitioned survival model was constructed， with a cycle of 3 weeks as the simulation of patients’ lifetime. The incremental cost-effectiveness ratio （ICER） was calculated by using quality-adjusted life years （QALY） as output indicators， and sensitivity analysis was used to verify the robustness of the basic analysis results； the cost-effectiveness of the second-line

treatment for

HER2

-positive metastatic breast cancer was compared between T-DXd and T-DM1.

RESULTS

Under the premise of taking 3 times China’s per capita gross domestic product （GDP） in 2022 as the willingness-to-pay threshold （257 094 yuan/QALY）， the T-DXd group also needed to pay more cost compared with T-DM1 group while obtaining incremental utility （0.69 QALYs）， and the ICER value was 1 850 478.40 yuan/QALY. The results of univariate sensitivity analysis showed that progression-free survival state utility value， T-DXd price， cost discount rate were factors that had a great influence on ICER value， but these parameters could not flip the basic analysis results within a reasonable range. In the probability sensitivity analysis， when the threshold of willingness-to-pay rose to 1 500 400 yuan/QALY， the probability of economic activity was 50% in the T-DXd regimen. The results of the scenario analysis also verified the robustness of the original research results.

CONCLUSIONS

Under the premise of 3 times China’s per capita GDP as the WTP threshold， compared with T-DM1， T-DXd is not cost-effective in the second-line treatment of

HER2

-positive metastatic breast cancer.

关键词

Keywords

references

SUNG H ， FERLAY J ， SIEGEL R L ， et al . Global cancer statistics 2020：GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin ， 2021 ， 71 （ 3 ）： 209 - 249 .

LEI S Y ， ZHENG R S ， ZHANG S W ， et al . Global patterns of breast cancer incidence and mortality：a population-based cancer registry data analysis from 2000 to 2020 [J ] . Cancer Commun ， 2021 ， 41 （ 11 ）： 1183 - 1194 .

CAO M M ， LI H ， SUN D Q ， et al . Cancer burden of major cancers in China：a need for sustainable actions [J ] . Cancer Commun ， 2020 ， 40 （ 5 ）： 205 - 210 .

SUN Y ， LI W Q ， LI A J ， et al . Increased systemic immune-inflammation index independently predicts poor survival for hormone receptor-negative，HER2-positive breast cancer patients [J ] . Cancer Manag Res ， 2019 ， 11 ： 3153 - 3162 .

李阁，谷瑞雪，刘旭，等 . Her-2阳性乳腺癌靶向治疗药物的研究进展 [J ] . 肿瘤学杂志， 2020 ， 26 （ 1 ）： 1 - 6 .

LI G ， GU R X ， LIU X ， et al . Research progress in treatment of Her-2-positive breast cancer with targeted agents [J ] . J Chin Oncol ， 2020 ， 26 （ 1 ）： 1 - 6 .

CAMERON D ， PICCART-GEBHART M J ， GELBER R D ， et al . 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer：final analysis of the HERceptin Adjuvant （HERA） trial [J ] . Lancet ， 2017 ， 389 （ 10075 ）： 1195 - 1205 .

HURVITZ S A ， HEGG R ， CHUNG W P ， et al . Trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer：updated results from DESTINY-Breast03，a randomised，open-label，phase 3 trial [J ] . Lancet ， 2023 ， 401 （ 10371 ）： 105 - 117 .

IM S A ， GENNARI A ， PARK Y H ， et al . Pan-Asian adapted ESMO clinical practice guidelines for the diag-nosis，staging and treatment of patients with metastatic breast cancer [J ] . ESMO Open ， 2023 ， 8 （ 3 ）： 101541 .

GRADISHAR W J ， MORAN M S ， ABRAHAM J ， et al . NCCN guidelines ® insights：breast cancer，version 4.2023 [J ] . J Natl Compr Canc Netw ， 2023 ， 21 （ 6 ）： 594 - 608 .

YANG J P ， HAN J Q ， ZHANG Y L ， et al . Cost-effectiveness analysis of trastuzumab deruxtecan versus trastuzumab emtansine for HER2-positive breast cancer [J ] . Front Pharmacol ， 2022 ， 13 ： 924126 .

ZHU Y W ， LIU K ， WANG M ， et al . Trastuzumab deruxtecan versus trastuzumab emtansine for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer：a cost-effectiveness analysis [J ] . Breast ， 2022 ， 66 ： 191 - 198 .

刘国恩 . 中国药物经济学评价指南2020 [M ] . 北京：中国市场出版社， 2020 ： 27 - 46 .

LIU G E . China guidelines for pharmacoeconomic evaluations 2020 [M ] . Beijing ： China Market Press ， 2020 ： 27 - 46 .

中国临床肿瘤学会 . 中国临床肿瘤学会（CSCO）乳腺癌诊疗指南 2023 [Ｍ ] . 北京：人民卫生出版社， 2023 ： 87 .

Chinese Society of Clinical Oncology . Chinese Society of Clinical Oncology（CSCO）guidelines for the diagnosis and treatment of breast cancer 2023 [M ] . Beijing ： People’s Medical Publishing House ， 2023 ： 87 .

SAURA C ， OLIVEIRA M ， FENG Y H ， et al . Neratinib plus capecitabine versus lapatinib plus capecitabine in HER2-positive metastatic breast cancer previously treated with ≥2 HER2-directed regimens：phase Ⅲ NALA trial [J ] . J Clin Oncol ， 2020 ， 38 （ 27 ）： 3138 - 3149 .

WU Y ， DONG Z ， WANG J F ， et al . Neratinib plus capecitabine versus lapatinib plus capecitabine as the third-line therapy for HER2-positive metastatic breast cancer in China：a cost-effectiveness analysis [J ] . BMJ Open ， 2022 ， 12 （ 11 ）： e065299 .

WANG H ， ZENG C X ， LI X ， et al . Cost-utility of afatinib and gefitinib as first-line treatment for EGFR-mutated advanced non-small-cell lung cancer [J ] . Future Oncol ， 2019 ， 15 （ 2 ）： 181 - 191 .

高红婷，胡梦雪，贾琳琳，等 . 信迪利单抗联合化疗一线治疗晚期或复发性非小细胞肺癌的成本-效用分析 [J ] . 中国药房， 2022 ， 33 （ 15 ）： 1854 - 1859 .

GAO H T ， HU M X ， JIA L L ， et al . Cost-utility analysis of sintilimab combined with chemotherapy in first-line treatment of advanced or recurrent non-small cell lung cancer [J ] . China Pharm ， 2022 ， 33 （ 15 ）： 1854 - 1859 .

YANG Q ， YU X X ， ZHANG W . Health variations among breast-cancer patients from different disease states：evidence from China [J ] . BMC Health Serv Res ， 2020 ， 20 （ 1 ）： 1033 .

DOI T ， SHITARA K ， NAITO Y ， et al . Safety，pharmacokinetics，and antitumour activity of trastuzumab deruxtecan（DS-8201），a HER2-targeting antibody-drug conjugate，in patients with advanced breast and gastric or gastro-oesophageal tumours：a phase 1 dose-escalation study [J ] . Lancet Oncol ， 2017 ， 18 （ 11 ）： 1512 - 1522 .

李欣 . 从肿瘤药物的慈善赠药谈我国的患者援助项目 [J ] . 西部学刊， 2022 （ 13 ）： 172 - 176 .

LI X . Discussion on patient assistance projects in China from the perspective of charitable donation of tumor drugs [J ] . J West ， 2022 （ 13 ）： 172 - 176 .

OGITANI Y ， AIDA T ， HAGIHARA K ， et al . DS-8201a，a novel HER2-targeting ADC with a novel DNA topoiso-merase Ⅰ inhibitor，demonstrates a promising antitumor efficacy with differentiation from T-DM1 [J ] . Clin Cancer Res ， 2016 ， 22 （ 20 ）： 5097 - 5108 .

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⁰

Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer

DOI：10.6039/j.issn.1001-0408.2024.02.14

摘要

Abstract

关键词

Keywords

references