Evidence map›Paper›PMID 40397834›Full record

ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2025

Cost and Cost-Effectiveness of Treating Human Epidermal Growth Factor Receptor 2-Low Metastatic Breast Cancer.

James C Dickerson, Marcus T Moen, Perry Nielsen, Fauzia Riaz, Edward Tran, Jennifer L Caswell-Jin, Wesley Suen, Jeremy D Goldhaber-Fiebert, Fernando Alarid-Escudero

Abstract read
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In one paragraph

Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–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

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Adagrasib in the treatment of KRASTranslational cancer research · 2025
    Article
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

9 authors.

James C DickersonDepartment of Medicine (Hematology and Oncology), Stanford University, Stanford, CA.ORCID 0000-0002-8935-2939
Marcus T MoenDepartment of Management Science and Engineering, Stanford University, Stanford, CA.
Perry NielsenDepartment of Health Policy, Stanford University, Stanford, CA.
Fauzia RiazDepartment of Medicine (Hematology and Oncology), Stanford University, Stanford, CA.ORCID 0000-0002-6267-3839
Edward TranDepartment of Management Science and Engineering, Stanford University, Stanford, CA.ORCID 0009-0005-4327-0291
Jennifer L Caswell-JinDepartment of Medicine (Hematology and Oncology), Stanford University, Stanford, CA.ORCID 0000-0002-5711-8355
Wesley SuenDepartment of Health Policy, Stanford University, Stanford, CA.ORCID 0009-0001-4713-2110
Jeremy D Goldhaber-FiebertDepartment of Health Policy, Stanford University, Stanford, CA.
Fernando Alarid-EscuderoDepartment of Health Policy, Stanford University, Stanford, CA.ORCID 0000-0001-5076-1172

Funding

AHRQ HHS T32 HS026128
6 · The paper itself

Abstract

purposeCreating value-aligned treatment pathways in breast cancer requires understanding the cost and cost-effectiveness of new therapies. To address uncertainty in the optimal treatment sequence, we developed a decision model to assess the cost-effectiveness of various treatment sequences for patients with human epidermal growth factor receptor 2 (HER2)-low metastatic breast cancer who are eligible for trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) under current US Food and Drug Administration labeling.

methodsWe derived disease progression and therapy data from the Destiny-Breast04 trial and sourced cost and quality-of-life data from the published literature. Our simulation modeled 57-year-old women with HER2-low, endocrine refractory, and triple-negative metastatic breast cancer eligible for third-line treatment. We evaluated four sequences: chemotherapy (chemo) → chemo, T-DXd → chemo, chemo → T-DXd, and T-DXd → SG. Outcomes included quality-adjusted life years (QALYs), total lifetime costs (2020 US dollars [USD], 3% annual discount), and incremental cost-effectiveness ratios. Sequences that cost <$150,000 USD to gain an additional QALY were considered cost effective.

resultsChemo → chemo has the lowest cost at $176,000 (USD) per patient and yields 0.82 QALYs. T-DXd → chemo costs $282,000 (USD) and yields 1.08 QALYs, with an incremental cost-effectiveness ratio of $408,000 (USD) per QALY gained. T-DXd → SG costs $304,000 (USD) and yields 1.09 QALYs, with an incremental cost-effectiveness ratio of $2,200,000 (USD) per QALY gained. Drug cost drives the cost differences between each strategy. For T-DXd → chemo to be cost effective at the $150,000 (USD) per QALY threshold, we estimate that a 41% price reduction for T-DXd is needed.

conclusionAt its current price, T-DXd is not cost effective for HER2-low metastatic breast cancer. Price reductions can make this drug cost effective. Optimal value-based sequencing in this patient population uses a single antibody-drug conjugate rather than back-to-back conjugates.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsDrug CostsErb-b2 Receptor Tyrosine KinasesAntibodies, Monoclonal, HumanizedCamptothecinCost-Benefit AnalysisFemaleHumansImmunoconjugatesMiddle AgedNeoplasm MetastasisQuality-Adjusted Life YearsQuality of LifeTrastuzumabAntibodies, Monoclonal, HumanizedCamptothecinERBB2 protein, humanErb-b2 Receptor Tyrosine KinasesImmunoconjugatesTrastuzumabtrastuzumab deruxtecan

Identifiers

PMID40397834
PMCPMC12331244

What OpenQuestion holds

Textmetadata
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.