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

  • Thomas E. Delea
  • Paul Tappenden
  • Oleg Sofrygin
  • Dominy Browning
  • Mayur M. Amonkar
  • Jon Karnon
  • Mel D. Walker
  • David Cameron
Original Paper

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Breast neoplasms, secondary Economics Cost and cost analysis Lapatinib 

JEL Classification

I1 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Thomas E. Delea
    • 1
  • Paul Tappenden
    • 2
  • Oleg Sofrygin
    • 1
  • Dominy Browning
    • 3
  • Mayur M. Amonkar
    • 4
  • Jon Karnon
    • 2
    • 5
  • Mel D. Walker
    • 3
  • David Cameron
    • 6
  1. 1.Policy Analysis Inc. (PAI)BrooklineUSA
  2. 2.School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
  3. 3.GlaxoSmithKlineLondonUK
  4. 4.GlaxoSmithKlineCollegevilleUSA
  5. 5.University of AdelaideAdelaideAustralia
  6. 6.Section of Oncology and Clinical ResearchUniversity of LeedsLeedsUK

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