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Cost-Effectiveness of Second-Line Endocrine Therapies in Postmenopausal Women with Hormone Receptor–positive and Human Epidermal Growth Factor Receptor 2–negative Metastatic Breast Cancer in Japan

Author

Listed:
  • Verin Lertjanyakun

    (Kyoto University)

  • Nathorn Chaiyakunapruk

    (Monash University Malaysia
    Naresuan University
    University of Wisconsin-Madison
    Monash University Malaysia)

  • Susumu Kunisawa

    (Kyoto University)

  • Yuichi Imanaka

    (Kyoto University)

Abstract

Background Exemestane (EXE), exemestane + everolimus (EXE + EVE), toremifene (TOR), and fulvestrant (FUL) are second-line endocrine therapies for postmenopausal hormone receptor–positive (HR +)/human epidermal growth factor receptor 2–negative (HER2 −) metastatic breast cancer (mBC) in Japan. Although the efficacy of these therapies has been shown in recent studies, cost-effectiveness has not yet been determined in Japan. Objective This study aimed to examine the cost-effectiveness of second-line endocrine therapies for the treatment of postmenopausal women with HR + and HER2 − mBC. Methods A Markov model was developed to analyze the cost-effectiveness of the therapies over a 15-year time horizon from a public healthcare payer’s perspective. The efficacy and utility parameters were determined via a systematic search of the literature. Direct medical care costs were used. A discount rate of 2% was applied for costs and outcomes. Subgroup analysis was performed for non-visceral metastasis. A series of sensitivity analyses, including probabilistic sensitivity analysis (PSA) and threshold analysis were performed. Results Base-case analyses estimated incremental cost-effectiveness ratios (ICERs) of 3 million and 6 million Japanese yen (JPY)/quality-adjusted life year (QALY) gained for TOR and FUL 500 mg relative to EXE, respectively. FUL 250 mg and EXE + EVE were dominated. The overall survival (OS) highly influenced the ICER. With a willingness-to-pay (WTP) threshold of 5 million JPY/QALY, the probability of TOR being cost-effective was the highest. Subgroup analysis in non-visceral metastasis revealed 0.4 and 10% reduction in ICER from the base-case results of FUL5 500 mg versus EXE and TOR versus EXE, respectively, while threshold analysis indicated EVE and FUL prices should be reduced 73 and 30%, respectively. Conclusion As a second-line therapy for postmenopausal women with HR +/HER2 − mBC, TOR may be cost-effective relative to other alternatives and seems to be the most favorable choice, based on a WTP threshold of 5 million JPY/QALY. FUL 250 mg is expected to be as costly and effective as EXE. The cost-effectiveness of EXE + EVE and FUL 500 mg could be improved by a large price reduction. However, the results are highly sensitive to the hazard ratio of OS. Policy makers should carefully interpret and utilize these findings.

Suggested Citation

  • Verin Lertjanyakun & Nathorn Chaiyakunapruk & Susumu Kunisawa & Yuichi Imanaka, 2018. "Cost-Effectiveness of Second-Line Endocrine Therapies in Postmenopausal Women with Hormone Receptor–positive and Human Epidermal Growth Factor Receptor 2–negative Metastatic Breast Cancer in Japan," PharmacoEconomics, Springer, vol. 36(9), pages 1113-1124, September.
    • Handle: RePEc:spr:pharme:v:36:y:2018:i:9:d:10.1007_s40273-018-0660-3
    DOI: 10.1007/s40273-018-0660-3
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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    2. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
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