Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective

Marcio Machado,1 Thomas R Einarson21GlaxoSmithKline Brasil Ltd, Rio de Janeiro, Brazil; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, CanadaObjective: To evaluate, from the perspective of the Brazilian public health care system, the cost-effectiveness of lapatinib plus capecitabin...

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Autores principales:	Machado M, Einarson TR
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/26edf50c4db44f8d930212a0cd253eea
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spelling	oai:doaj.org-article:26edf50c4db44f8d930212a0cd253eea2021-12-02T07:16:16ZLapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective1179-1314https://doaj.org/article/26edf50c4db44f8d930212a0cd253eea2012-11-01T00:00:00Zhttp://www.dovepress.com/lapatinib-in-patients-with-metastatic-breast-cancer-following-initial--a11513https://doaj.org/toc/1179-1314Marcio Machado,1 Thomas R Einarson21GlaxoSmithKline Brasil Ltd, Rio de Janeiro, Brazil; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, CanadaObjective: To evaluate, from the perspective of the Brazilian public health care system, the cost-effectiveness of lapatinib plus capecitabine (LAP/CAP) versus capecitabine alone (CAP) or trastuzumab plus capecitabine (TRAST/CAP) in the treatment of women with human epidermal growth factor receptor-2-positive metastatic breast cancer previously treated with trastuzumab.Methods: An economic model was developed to compare costs and clinical outcomes over a 5-year time horizon. Both costs and outcomes were discounted at a 5% rate, in accordance with Brazilian pharmacoeconomic guidelines. Clinical inputs were determined using indirect treatment comparisons. Costs were derived from public reimbursement databases and reported in 2010 Brazilian real (R$1 = USD$0.52). Clinical outcomes included progression-free survival years (PFYs), life-years (LYs) and quality-adjusted life-years (QALYs). The economic outcome was the incremental cost per LY, PFY, or QALY gained. The impact of variations in individual inputs (eg, drug cost, drug effectiveness) was examined using one-way sensitivity analyses. Overall model robustness was tested using probabilistic sensitivity analyses, varying the ranges of all input parameters within their standard distributions.Results: Expected cost per patient was R$41,195 for CAP, R$95,256 for LAP/CAP, and R$113,686 for TRAST/CAP. Respective LYs were 1.406, 1.695, and 1.465; PFYs were 0.473, 0.711, and 0.612; and QALYS were 0.769, 0.958, and 0.827. LAP/CAP dominated TRAST/CAP for all outcomes. Incremental cost-effectiveness ratios of LAP/CAP over CAP were R$186,563 for LYs, R$226,403 for PFYs, and R$284,864 for QALYs. Results remained unchanged in one-way sensitivity analyses. In probabilistic analyses, LAP/CAP was dominant over TRAST/CAP in 93.5% of simulations.Conclusion: LAP/CAP increases survival for women with human epidermal growth factor receptor-2-positive metastatic breast cancer. LAP/CAP is cost-effective against TRAST/CAP (ie, produces more benefits at a lower cost) and can be considered cost-effective over CAP at a willingness-to-pay of about R$290,000 (US$151,000) per QALY gained.Keywords: cost-effectiveness, metastatic breast cancer, lapatinib, trastuzumab, capecitabineMachado MEinarson TRDove Medical PressarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol 2012, Iss default, Pp 173-182 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Machado M Einarson TR Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
description	Marcio Machado,1 Thomas R Einarson21GlaxoSmithKline Brasil Ltd, Rio de Janeiro, Brazil; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, CanadaObjective: To evaluate, from the perspective of the Brazilian public health care system, the cost-effectiveness of lapatinib plus capecitabine (LAP/CAP) versus capecitabine alone (CAP) or trastuzumab plus capecitabine (TRAST/CAP) in the treatment of women with human epidermal growth factor receptor-2-positive metastatic breast cancer previously treated with trastuzumab.Methods: An economic model was developed to compare costs and clinical outcomes over a 5-year time horizon. Both costs and outcomes were discounted at a 5% rate, in accordance with Brazilian pharmacoeconomic guidelines. Clinical inputs were determined using indirect treatment comparisons. Costs were derived from public reimbursement databases and reported in 2010 Brazilian real (R$1 = USD$0.52). Clinical outcomes included progression-free survival years (PFYs), life-years (LYs) and quality-adjusted life-years (QALYs). The economic outcome was the incremental cost per LY, PFY, or QALY gained. The impact of variations in individual inputs (eg, drug cost, drug effectiveness) was examined using one-way sensitivity analyses. Overall model robustness was tested using probabilistic sensitivity analyses, varying the ranges of all input parameters within their standard distributions.Results: Expected cost per patient was R$41,195 for CAP, R$95,256 for LAP/CAP, and R$113,686 for TRAST/CAP. Respective LYs were 1.406, 1.695, and 1.465; PFYs were 0.473, 0.711, and 0.612; and QALYS were 0.769, 0.958, and 0.827. LAP/CAP dominated TRAST/CAP for all outcomes. Incremental cost-effectiveness ratios of LAP/CAP over CAP were R$186,563 for LYs, R$226,403 for PFYs, and R$284,864 for QALYs. Results remained unchanged in one-way sensitivity analyses. In probabilistic analyses, LAP/CAP was dominant over TRAST/CAP in 93.5% of simulations.Conclusion: LAP/CAP increases survival for women with human epidermal growth factor receptor-2-positive metastatic breast cancer. LAP/CAP is cost-effective against TRAST/CAP (ie, produces more benefits at a lower cost) and can be considered cost-effective over CAP at a willingness-to-pay of about R$290,000 (US$151,000) per QALY gained.Keywords: cost-effectiveness, metastatic breast cancer, lapatinib, trastuzumab, capecitabine
format	article
author	Machado M Einarson TR
author_facet	Machado M Einarson TR
author_sort	Machado M
title	Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
title_short	Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
title_full	Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
title_fullStr	Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
title_full_unstemmed	Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective
title_sort	lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the brazilian public health care perspective
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/26edf50c4db44f8d930212a0cd253eea
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Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: an economic analysis from the Brazilian public health care perspective

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