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Cost-Effectiveness Analysis of Trastuzumab Deruxtecan versus Trastuzumab Emtansine in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer in the USA

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Abstract

Introduction

Based on data from the DESTINY-Breast03 trial, we performed a cost-effectiveness analysis of trastuzumab deruxtecan (T-DXd) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer who had been previously treated with trastuzumab and a taxane from the US payer perspective.

Methods

We conducted a Markov model to assess the cost-effectiveness of T-DXd versus trastuzumab emtansine (T-DM1). The simulation time horizon for this model was the lifetime of patients. Transition probabilities were based on data from the DESTINY-Breast03 trial. Health utility data were derived from published studies. Outcome measures were costs (in 2022 US$), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses assessed the uncertainty of key model parameters and their joint impact on the base-case results.

Results

The base-case results found that T-DXd provided an improvement of 3.90 QALYs compared with T-DM1, and the ICER was $220,533 per QALY. The one-way sensitivity analysis demonstrated that the utility value of progression-free survival, hazard ratios of T-Dxd versus T-DM1, and cost of T-Dxd contributed substantial uncertainty to the model. Probabilistic sensitivity analysis predicted T-DXd being cost-effective compared to T-DM1 was 0, 1, 16, and 46% at willingness-to-pay of $50,000, $100,000, $150,000, and 200,000 per QALY, respectively.

Conclusion

T-DXd was unlikely to offer a reasonable value for the money spent compared to T-DM1 in a US payer setting.

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Acknowledgements

Funding

The work was supported by grant from the National Natural Science Foundation of China (Grant Numbers: 82073818). The journal’s Rapid Service Fee was funded by the authors.

Author Contributions

Study design and supervision: Chongqing Tan; data analysis and interpretation: Jingyan Wang, Yinzhi Yi; data collection: Xiaomin Wan, Xiaohui Zeng, Ye Peng; manuscript writing: Jingyan Wang; final approval of manuscript: All authors.

Disclosures

Jingyan Wang, Yinzhi Yi, Xiaomin Wan, Xiaohui Zeng, Ye Peng, Chongqing Tan declare that they have no competing interests.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Pediatric Orthopedics, The Hunan Children’s Hospital, Changsha, 410011, Hunan, China

    Jingyan Wang & Yinzhi Yi

  2. Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Xiaomin Wan, Ye Peng & Chongqing Tan

  3. PET-CT Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Xiaohui Zeng

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  1. Jingyan Wang
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Correspondence to Chongqing Tan.

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Wang, J., Yi, Y., Wan, X. et al. Cost-Effectiveness Analysis of Trastuzumab Deruxtecan versus Trastuzumab Emtansine in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer in the USA. Adv Ther 39, 4583–4593 (2022). https://doi.org/10.1007/s12325-022-02273-4

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