Evidence map›Paper›PMID 27654970›Full record

ArticleBreast cancer research and treatment2016

Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States.

Vakaramoko Diaby, Georges Adunlin, Askal A Ali, Simon B Zeichner, Gilberto de Lima Lopes, Christine G Kohn, Alberto J Montero

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast cancer research and treatment, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Systematic Review of the Cost Effectiveness of Breast Cancer Prevention, Screening, and Treatment Interventions.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2020
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  11. Cost-Effectiveness of Pharmacologic Treatment Options for Women With Endocrine-Refractory or Triple-Negative Metastatic Breast Cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Vakaramoko DiabyEconomic, Social & Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, 200 Dyson Pharmacy Bldg., 1520 Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA. diaby_v@yahoo.fr.
Georges AdunlinDepartment of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, PO Box 980149, Richmond, VA, 23298, USA.
Askal A AliEconomic, Social & Administrative Pharmacy, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, 200 Dyson Pharmacy Bldg., 1520 Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA.
Simon B ZeichnerWinship Cancer Institute at Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA.
Gilberto de Lima LopesOncoclinicas Group, Avenida Faria Lima 4300, 15 andar, São Paulo, SP, Brazil.
Christine G KohnHealth Economics and Outcomes Research, University of Saint Joseph School of Pharmacy, UConn/Hartford Hospital Evidence-based Practice Center, 229 Trumbull Street, Hartford, CT, 06103, USA.
Alberto J MonteroDepartment of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.

Funding

Recruitment and HiringG12MD007582 · NIMHD · FLORIDA AGRICULTURAL AND MECHANICAL UNIV · PI SOLIMAN, KARAM F.A. · 2012 to 2017
$16.0M
Targeted Nanocarrier Combination Based Therapy for Lung CancerP20MD006738 · NIMHD · FLORIDA AGRICULTURAL AND MECHANICAL UNIV · PI RAHMAN, SALEH MD. MAHMUDUR · 2012 to 2016
$5.6M
Training Program in Behavioral and Health Services Cancer Control ResearchR25CA093423 · NCI · VIRGINIA COMMONWEALTH UNIVERSITY · PI BROWN, RICHARD FREDERICK · 2002 to 2015
$2.9M
NCI NIH HHS R25 CA093423NIMHD NIH HHS G12 MD007582NIMHD NIH HHS P20 MD006738
6 · The paper itself

Abstract

purposeBased on available phase III trial data, we performed a cost-effectiveness analysis of different treatment strategies that can be used in patients with newly diagnosed HER2-positive metastatic breast cancer (mBC). PATIENTS AND

methodsWe constructed a Markov model to assess the cost-effectiveness of four different HER2 targeted treatment sequences in patients with HER2-positive mBC treated in the U.S. The model followed patients weekly over their remaining life expectancies. Health states considered were progression-free survival (PFS) 1st to 3rd lines, and death. Transitional probabilities were based on published phase III trials. Cost data (2015 US dollars) were captured from the U.S. Centers for Medicare and Medicaid Services (CMS) drug payment table and physician fee schedule. Health utility data were extracted from published studies. The outcomes considered were PFS, OS, costs, QALYs, the incremental cost per QALY gained ratio, and the net monetary benefit. Deterministic and probabilistic sensitivity analyses assessed the uncertainty around key model parameters and their joint impact on the base-case results.

resultsThe combination of trastuzumab, pertuzumab, and docetaxel (THP) as first-line therapy, trastuzumab emtansine (T-DM1) as second-line therapy, and lapatinib/capecitabine third-line resulted in 1.81 QALYs, at a cost of $335,231.35. The combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab yielded 1.41 QALYs, at a cost of $175,240.69. The least clinically effective sequence (1.27 QALYs), but most cost-effective at a total cost of $149,250.19, was trastuzumab/docetaxel as first-line therapy, T-DM1 as second-line therapy, and trastuzumab/lapatinib as third-line therapy.

conclusionOur results suggest that THP as first-line therapy, followed by T-DM1 as second-line therapy, would require at least a 50 % reduction in the total drug acquisition cost for it to be considered a cost-effective strategy.

Indexed as

Cost-Benefit AnalysisAntineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsClinical Trials, Phase III as TopicErb-b2 Receptor Tyrosine KinasesFemaleHealth Care CostsHealth ResourcesHumansMarkov ChainsMolecular Targeted TherapyNeoplasm MetastasisNeoplasm StagingPatient Acceptance of Health CareUnited StatesErb-b2 Receptor Tyrosine Kinasesbreast cancercost-effectiveness analysisHER2-positivelapatinibMarkovmetastatic breast cancerpertuzumabsequential therapyT-DM1Trastuzumab

Identifiers

PMID27654970
PMCPMC5329168

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.