Cost-effectiveness model of trastuzumab deruxtecan as second-line treatment in HER2-positive unresectable and/or metastatic breast cancer in Finland
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Published:2023-07-24
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Volume:
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ISSN:1618-7598
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Container-title:The European Journal of Health Economics
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language:en
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Short-container-title:Eur J Health Econ
Author:
Paulissen Jeroen H. J.ORCID, Seddik Ahmed H.ORCID, Dunton Kyle J., Livings Christopher J., van Hulst MarinusORCID, Postma Maarten J.ORCID, de Jong Lisa A.ORCID, Freriks Roel D.ORCID
Abstract
AbstractObjectivesTrastuzumab deruxtecan (T-DXd) was recently recommended by the Committee for Medicinal Products for Human Use as a treatment for adult patients with unresectable or metastatic HER2-positive breast cancer, who had received a prior anti-HER2-based regimen. In our study, we evaluated the cost-effectiveness of T-DXd compared with ado-trastuzumab emtansine (T-DM1) for this indication in Finland.MethodsA three-state partitioned survival analysis model was developed with a payer’s perspective. Time to event data from the DESTINY-Breast03 (DB-03) trial were extrapolated over a lifetime horizon either directly—for progression-free survival and time to treatment discontinuation—or using an alternative approach utilizing long-term T-DM1 survival data and DB-03 data—for overall survival. Discount rates of 3% were applied for costs and effects. Inputs were sourced from the Medicinal Products Database from Kela, Helsinki University Hospital service price list, Finnish Medicines Agency assessments, clinical experts, and DB-03. Sensitivity analyses were performed to characterize and demonstrate parameter uncertainties in the model.ResultsTotal quality-adjusted life years (QALYs) and life years (LYs) gained for T-DXd compared with T-DM1 were 1.93 and 2.56, respectively. Incremental costs for T-DXd compared with T-DM1 were €106,800, resulting in an ICER of €55,360 per QALY gained and an ICER of €41,775 per LY gained. One-way sensitivity analysis showed the hazard ratio of T-DXd vs T-DM1 for OS was the most influential parameter. The probabilistic sensitivity analysis showed similar results to the base case.ConclusionsT-DXd is cost-effective based on surrogate WTP thresholds of €72,000 and €139,000 per QALY.
Funder
Daiichi Sankyo International AstraZeneca
Publisher
Springer Science and Business Media LLC
Subject
Health Policy,Economics, Econometrics and Finance (miscellaneous)
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