The European Journal of Health Economics

, Volume 13, Issue 5, pp 589–603

Cost-effectiveness of lapatinib plus capecitabine in women with HER2+ metastatic breast cancer who have received prior therapy with trastuzumab


    • Policy Analysis Inc. (PAI)
  • Paul Tappenden
    • School of Health and Related Research (ScHARR)University of Sheffield
  • Oleg Sofrygin
    • Policy Analysis Inc. (PAI)
  • Dominy Browning
    • GlaxoSmithKline
  • Mayur M. Amonkar
    • GlaxoSmithKline
  • Jon Karnon
    • School of Health and Related Research (ScHARR)University of Sheffield
    • University of Adelaide
  • Mel D. Walker
    • GlaxoSmithKline
  • David Cameron
    • Section of Oncology and Clinical ResearchUniversity of Leeds
Original Paper

DOI: 10.1007/s10198-011-0323-1

Cite this article as:
Delea, T.E., Tappenden, P., Sofrygin, O. et al. Eur J Health Econ (2012) 13: 589. doi:10.1007/s10198-011-0323-1



In a phase III trial of women with HER2+ metastatic breast cancer (MBC) previously treated with trastuzumab, an anthracycline, and taxanes (EGF100151), lapatinib plus capecitabine (L + C) improved time to progression (TTP) versus capecitabine monotherapy (C-only). In a trial including HER2+ MBC patients who had received at least one prior course of trastuzumab and no more than one prior course of palliative chemotherapy (GBG 26/BIG 03-05), continued trastuzumab plus capecitabine (T + C) also improved TTP.


An economic model using patient-level data from EGF100151 and published results of GBG 26/BIG 03-05 as well as other literature were used to evaluate the incremental cost per quality-adjusted life-year [QALY] gained with L + C versus C-only and versus T + C in women with HER2+ MBC previously treated with trastuzumab from the UK National Health Service (NHS) perspective.


Expected costs were £28,816 with L + C, £13,985 with C-only and £28,924 with T + C. Corresponding QALYs were 0.927, 0.737 and 0.896. In the base case, L + C was estimated to provide more QALYs at a lower cost compared with T + C; cost per QALY gained was £77,993 with L + C versus C-only. In pairwise probabilistic sensitivity analyses, the probability that L + C is preferred to C-only was 0.03 given a threshold of £30,000. The probability that L + C is preferred to T + C was 0.54 regardless of the threshold.


When compared against capecitabine alone, the addition of lapatinib has a cost-effectiveness ratio exceeding the threshold normally used by NICE. Compared with T + C, L + C is dominant in the base case and approximately equally likely to be cost-effective in probabilistic sensitivity analyses over a wide range of threshold values.


Breast neoplasms, secondaryEconomicsCost and cost analysisLapatinib

JEL Classification


Copyright information

© Springer-Verlag 2011