Cost-effectiveness model of trastuzumab deruxtecan as second-line treatment in HER2-positive unresectable and/or metastatic breast cancer in Finland

Jeroen H. J. Paulissen (), Ahmed H. Seddik, Kyle J. Dunton, Christopher J. Livings, Marinus Hulst, Maarten J. Postma, Lisa A. Jong and Roel D. Freriks
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Jeroen H. J. Paulissen: University Medical Center Groningen
Ahmed H. Seddik: Daiichi Sankyo Europe GmbH
Kyle J. Dunton: Daiichi Sankyo UK Ltd
Christopher J. Livings: AstraZeneca Plc.
Marinus Hulst: University Medical Center Groningen
Maarten J. Postma: University Medical Center Groningen
Lisa A. Jong: University Medical Center Groningen
Roel D. Freriks: Asc Academics

The European Journal of Health Economics, 2024, vol. 25, issue 4, No 10, 689-699

Abstract: Abstract Objectives Trastuzumab deruxtecan (T-DXd) was recently recommended by the Committee for Medicinal Products for Human Use as a treatment for adult patients with unresectable or metastatic HER2-positive breast cancer, who had received a prior anti-HER2-based regimen. In our study, we evaluated the cost-effectiveness of T-DXd compared with ado-trastuzumab emtansine (T-DM1) for this indication in Finland. Methods A three-state partitioned survival analysis model was developed with a payer’s perspective. Time to event data from the DESTINY-Breast03 (DB-03) trial were extrapolated over a lifetime horizon either directly—for progression-free survival and time to treatment discontinuation—or using an alternative approach utilizing long-term T-DM1 survival data and DB-03 data—for overall survival. Discount rates of 3% were applied for costs and effects. Inputs were sourced from the Medicinal Products Database from Kela, Helsinki University Hospital service price list, Finnish Medicines Agency assessments, clinical experts, and DB-03. Sensitivity analyses were performed to characterize and demonstrate parameter uncertainties in the model. Results Total quality-adjusted life years (QALYs) and life years (LYs) gained for T-DXd compared with T-DM1 were 1.93 and 2.56, respectively. Incremental costs for T-DXd compared with T-DM1 were €106,800, resulting in an ICER of €55,360 per QALY gained and an ICER of €41,775 per LY gained. One-way sensitivity analysis showed the hazard ratio of T-DXd vs T-DM1 for OS was the most influential parameter. The probabilistic sensitivity analysis showed similar results to the base case. Conclusions T-DXd is cost-effective based on surrogate WTP thresholds of €72,000 and €139,000 per QALY.

Keywords: Cost-effectiveness; Breast cancer; Metastatic; HER2-positive; Trastuzumab deruxtecan (search for similar items in EconPapers)
JEL-codes: D61 (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01617-3

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