Cost-effectiveness analysis of 1st through 3rd line sequential targeted therapy in HER2-positive metastatic breast cancer in the United States.


PURPOSE:Based on available phase III trial data, we performed a cost-effectiveness analysis of different treatment strategies that can be used in patients with newly diagnosed HER2-positive metastatic breast cancer (mBC). PATIENTS AND METHODS:We constructed a Markov model to assess the cost-effectiveness of four different HER2 targeted treatment sequences in patients with HER2-positive mBC treated in the U.S. The model followed patients weekly over their remaining life expectancies. Health states considered were progression-free survival (PFS) 1st to 3rd lines, and death. Transitional probabilities were based on published phase III trials. Cost data (2015 US dollars) were captured from the U.S. Centers for Medicare and Medicaid Services (CMS) drug payment table and physician fee schedule. Health utility data were extracted from published studies. The outcomes considered were PFS, OS, costs, QALYs, the incremental cost per QALY gained ratio, and the net monetary benefit. Deterministic and probabilistic sensitivity analyses assessed the uncertainty around key model parameters and their joint impact on the base-case results. RESULTS:The combination of trastuzumab, pertuzumab, and docetaxel (THP) as first-line therapy, trastuzumab emtansine (T-DM1) as second-line therapy, and lapatinib/capecitabine third-line resulted in 1.81 QALYs, at a cost of $335,231.35. The combination of trastuzumab/docetaxel as first line without subsequent T-DM1 or pertuzumab yielded 1.41 QALYs, at a cost of $175,240.69. The least clinically effective sequence (1.27 QALYs), but most cost-effective at a total cost of $149,250.19, was trastuzumab/docetaxel as first-line therapy, T-DM1 as second-line therapy, and trastuzumab/lapatinib as third-line therapy. CONCLUSION:Our results suggest that THP as first-line therapy, followed by T-DM1 as second-line therapy, would require at least a 50 % reduction in the total drug acquisition cost for it to be considered a cost-effective strategy.


Diaby V,Adunlin G,Ali AA,Zeichner SB,de Lima Lopes G,Kohn CG,Montero AJ




Has Abstract


2016-11-01 00:00:00














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    abstract:PURPOSE:Clinical trials demonstrated adjuvant aromatase inhibitor treatment is superior for decreasing breast cancer recurrence risk over adjuvant tamoxifen treatment as early as 2001. Yet clinical use for adjuvant treatment was not recommended by the American Society of Clinical Oncology until 2004. Aromatase inhibito...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Aiello EJ,Buist DS,Wagner EH,Tuzzio L,Greene SM,Lamerato LE,Field TS,Herrinton LJ,Haque R,Hart G,Bischoff KJ,Geiger AM

    更新日期:2008-02-01 00:00:00

  • Taste and smell perception and quality of life during and after systemic therapy for breast cancer.

    abstract:PURPOSE:The purpose of the study was to assess self-reported taste and smell perception after chemotherapy in breast cancer patients compared with women without cancer, and to assess whether taste and smell perception is associated with quality of life after the end of chemotherapy. METHODS:We included 135 newly diagn...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: de Vries YC,Boesveldt S,Kelfkens CS,Posthuma EE,van den Berg MMGA,de Kruif JTCM,Haringhuizen A,Sommeijer DW,Buist N,Grosfeld S,de Graaf C,van Laarhoven HWM,Kampman E,Winkels RM

    更新日期:2018-07-01 00:00:00

  • Phase I/II study of paclitaxel and vinorelbine in metastatic breast cancer.

    abstract::Paclitaxel and vinorelbine are among the most active new agents in metastatic breast cancer. Both in vitro and in vivo studies have shown that the combined administration of these two microtubule-targeting agents is feasible and worthwhile. Based on the promising preclinical data, patients with metastatic breast cance...

    journal_title:Breast cancer research and treatment

    pub_type: 临床试验,杂志文章


    authors: Tortoriello A,Facchini G,Caponigro F,Santangelo M,Benassai G,Persico G,Citarella A,Carola M,Marzano N,Iaffaioli RV

    更新日期:1998-01-01 00:00:00

  • Utility of ankyrin 3 as a prognostic marker in androgen-receptor-positive breast cancer.

    abstract:PURPOSE:Androgen receptor (AR) and AR signaling pathways are thought to play a role in breast cancer (BC) and are potentially related to treatment responses and outcomes. Ankyrin 3 (ANK3) is associated with AR stability in cancer cells. In the present study, we investigated the clinicopathological utility of ANK3 expre...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Kurozumi S,Joseph C,Raafat S,Sonbul S,Kariri Y,Alsaeed S,Pigera M,Alsaleem M,Nolan CC,Johnston SJ,Aleskandarany MA,Ogden A,Fujii T,Shirabe K,Martin SG,Alshankyty I,Mongan NP,Ellis IO,Green AR,Rakha EA

    更新日期:2019-07-01 00:00:00

  • Infiltrating S100A8+ myeloid cells promote metastatic spread of human breast cancer and predict poor clinical outcome.

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Drews-Elger K,Iorns E,Dias A,Miller P,Ward TM,Dean S,Clarke J,Campion-Flora A,Rodrigues DN,Reis-Filho JS,Rae JM,Thomas D,Berry D,El-Ashry D,Lippman ME

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  • Axillary evaluation and lymphedema in women with ductal carcinoma in situ.

    abstract::Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Coromilas EJ,Wright JD,Huang Y,Feldman S,Neugut AI,Hillyer GC,Chen L,Hershman DL

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  • Impact of videotaped information on frequency and confidence of breast self-examination.

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    journal_title:Breast cancer research and treatment

    pub_type: 临床试验,杂志文章,随机对照试验


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  • Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients.

    abstract::The present study consists of 1,238 women with unilateral breast cancer treated with modified radical mastectomy living in the geographic area of Haukeland Hospital. Their weight and height had been measured years before presentation of the disease. Age-adjusted Quetelet's index (weight/height2) showed that obese wome...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Maehle BO,Tretli S

    更新日期:1996-01-01 00:00:00

  • Stage-specific survival has improved for young breast cancer patients since 2000: but not equally.

    abstract:PURPOSE:The stage-specific survival of young breast cancer patients has improved, likely due to diagnostic and treatment advances. We addressed whether survival improvements have reached all socioeconomic groups in a country with universal health care and national treatment guidelines. METHODS:Using Norwegian registry...

    journal_title:Breast cancer research and treatment

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    authors: Trewin CB,Johansson ALV,Hjerkind KV,Strand BH,Kiserud CE,Ursin G

    更新日期:2020-07-01 00:00:00

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    authors: Liu Y,Malin JL,Diamant AL,Thind A,Maly RC

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    abstract:PURPOSE:Fiber rich foods and dairy products have been suggested to be associated with breast cancer prognosis, though existing research is limited and either report on pre- or post-diagnostic dietary intake in relation to breast cancer prognosis. We investigated the associations between intake of whole grain (WG) and d...

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    pub_type: 杂志文章


    authors: Andersen JLM,Hansen L,Thomsen BLR,Christiansen LR,Dragsted LO,Olsen A

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    pub_type: 杂志文章


    authors: Nangia-Makker P,Sarvis R,Visscher DW,Bailey-Penrod J,Raz A,Sarkar FH

    更新日期:1998-05-01 00:00:00

  • The prognostic impact of age in different molecular subtypes of breast cancer.

    abstract::Breast cancer is a heterogeneous entity composed of distinct molecular subgroups with different molecular and clinical features. We analyzed the association between molecular breast cancer subgroups, age at diagnosis, and prognosis in a compilation of publicly available gene expression datasets. Affymetrix gene expres...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Liedtke C,Rody A,Gluz O,Baumann K,Beyer D,Kohls EB,Lausen K,Hanker L,Holtrich U,Becker S,Karn T

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  • Differential retention of rhodamine 123 by breast carcinoma and normal human mammary tissue.

    abstract::We have qualitatively evaluated the retention of the fluorescent dye rhodamine 123 by malignant or non-malignant breast epithelial cells in passively-infused fresh surgical specimens. Our findings demonstrate a microscopically-visible increase in the ability of primary and metastatic tumor cells to retain the dye, as ...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Dairkee SH,Hackett AJ

    更新日期:1991-03-01 00:00:00

  • Fulvestrant 500 mg versus anastrozole 1 mg for the first-line treatment of advanced breast cancer: follow-up analysis from the randomized 'FIRST' study.

    abstract::Fulvestrant fIRst-line Study comparing endocrine Treatments is a phase II, randomized, open-label study comparing fulvestrant 500 mg with anastrozole 1 mg as first-line endocrine therapy for postmenopausal women with hormone receptor-positive (HR+) advanced breast cancer. At data cut-off, only 36 % of patients had pro...

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    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Robertson JF,Lindemann JP,Llombart-Cussac A,Rolski J,Feltl D,Dewar J,Emerson L,Dean A,Ellis MJ

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  • The clinical value of preoperative wire localization of breast lesions by magnetic resonance imaging--a multicenter study.

    abstract::To evaluate the clinical value of MRI guided preoperative wire localization of clinically and mammographically occult lesions of the breast. In a multicenter study, we evaluated 132 preoperative MRI guided localizations. Median lesion size evaluated by MRI prior to wire localization was 9mm. MRI guided localization wa...

    journal_title:Breast cancer research and treatment

    pub_type: 临床试验,杂志文章,多中心研究


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  • Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis.

    abstract::Triple-negative breast cancer (TNBC) is a subtype of breast tumor with unique characteristics in terms of clinical-pathological presentation, prognosis, and response to therapy. Epidemiological investigations focusing on the identification of risk factors involved in the onset and progression of TNBCs have identified ...

    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章,meta分析,评审


    authors: Pierobon M,Frankenfeld CL

    更新日期:2013-01-01 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Zhi WI,Chen P,Kwon A,Chen C,Harte SE,Piulson L,Li S,Patil S,Mao JJ,Bao T

    更新日期:2019-12-01 00:00:00

  • Involvement of early growth response factors in TNFα-induced aromatase expression in breast adipose.

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    pub_type: 杂志文章


    authors: To SQ,Simpson ER,Knower KC,Clyne CD

    更新日期:2013-02-01 00:00:00

  • Correction to: Association between lifestyle, menstrual/reproductive history, and histological factors and risk of breast cancer in women biopsied for benign breast disease.

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    pub_type: 杂志文章,已发布勘误


    authors: Arthur R,Wang Y,Ye K,Glass AG,Ginsberg M,Loudig O,Rohan T

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    pub_type: 临床试验,杂志文章


    authors: Mariani G,Tagliabue P,Zucchinelli P,Brambilla C,Demicheli R,Villa E,Marchianò A,Valagussa P,Bonadonna G,Gianni L

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章,评审


    authors: Offodile AC 2nd,Sheckter CC,Tucker A,Watzker A,Ottino K,Zammert M,Padula WV

    更新日期:2017-10-01 00:00:00

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    journal_title:Breast cancer research and treatment

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    authors: Yong M,Jensen AÖ,Jacobsen JB,Nørgaard M,Fryzek JP,Sørensen HT

    更新日期:2011-09-01 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Mamby CC,Love RR,Feyzi JM

    更新日期:1994-01-01 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Jatoi I,Tsimelzon A,Weiss H,Clark GM,Hilsenbeck SG

    更新日期:2005-01-01 00:00:00

  • Association between financial burden and adjuvant hormonal therapy adherence and persistent use for privately insured women aged 18-64 years in BCBS of Texas.

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Kim J,Rajan SS,Du XL,Franzini L,Giordano SH,Morgan RO

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Furstenau DK,Mitra N,Wan F,Lewis R,Feldman MD,Fraker DL,Guvakova MA

    更新日期:2011-09-01 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Tzekaki EE,Geromichalos G,Lavrentiadou SN,Tsantarliotou MP,Pantazaki AA,Papaspyropoulos A

    更新日期:2021-01-03 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章


    authors: Calafat J,Janssen H

    更新日期:1984-01-01 00:00:00

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    journal_title:Breast cancer research and treatment

    pub_type: 杂志文章,评审


    authors: Pal SK,Childs BH,Pegram M

    更新日期:2011-02-01 00:00:00