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

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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.

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Acknowledgments

Funding for this study was provided by GlaxoSmithKline. The authors wish to thank Peter J. Mulley, Konstantinos Lykopoulos and Helen Rudge for their valuable assistance.

Conflict of interest

Thomas E. Delea and Oleg Sofrygin are employees of PAI, an independent contract research organization, which has received research support and consulting fees from GlaxoSmithKline and Genentech. Paul Tappenden and Jonathan Karnon have received research support from GlaxoSmithKline. Mayur Amonkar, Dominy Browning and Mel Walker are employees of GlaxoSmithKline and own stock or stock options in GlaxoSmithKline. David Cameron has consulted for, and received honoraria from, both GlaxoSmithKline and Roche.

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Authors and Affiliations

  1. Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

    Thomas E. Delea & Oleg Sofrygin

  2. School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK

    Paul Tappenden & Jon Karnon

  3. GlaxoSmithKline, London, UK

    Dominy Browning & Mel D. Walker

  4. GlaxoSmithKline, Collegeville, PA, USA

    Mayur M. Amonkar

  5. University of Adelaide, Adelaide, Australia

    Jon Karnon

  6. Section of Oncology and Clinical Research, University of Leeds, Leeds, LS2 9LN, UK

    David Cameron

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  1. Thomas E. Delea
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Correspondence to Thomas E. Delea.

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Delea, T.E., Tappenden, P., Sofrygin, O. et al. Cost-effectiveness of lapatinib plus capecitabine in women with HER2+ metastatic breast cancer who have received prior therapy with trastuzumab. Eur J Health Econ 13, 589–603 (2012). https://doi.org/10.1007/s10198-011-0323-1

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