Cost-effectiveness analysis of everolimus plus exemestane versus exemestane alone for treatment of hormone receptor positive metastatic breast cancer

Vakaramoko Diaby, Georges Adunlin, Simon B. Zeichner, Kiran Avancha, Gilberto Lopes, Stefan Gluck, Alberto J. Montero

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Everolimus in combination with exemestane significantly improved progression-free survival compared to exemestane alone in patients previously treated with non-steroidal aromatase inhibitors in the BOLERO-2 trial. As a result, this combination has been approved by the food and drug administration to treat postmenopausal women with hormone receptor positive and HER2 negative metastatic breast cancer. A cost-effectiveness analysis was conducted to determine whether everolimus represents good value for money, utilizing data from BOLERO-2. A decision-analytic model was used to estimate the incremental cost-effectiveness ratio between treatment arms of the BOLERO-2 trial. Costs were obtained from the Center for Medicare Services drug payment table and physician fee schedule. Benefits were expressed as quality-adjusted progression-free survival weeks (QAPFW) and quality-adjusted progression-free years (QAPFY), with utilities/disutilities derived from the literature. Deterministic and probabilistic sensitivity analyses were performed. A willingness to pay threshold of 1–3 times the per capita gross domestic product was adopted, as per the definition of the World Health Organization. The U.S. per capita gross domestic product in 2013 was $49,965; thus, a threshold varying between $49,965 and $149,895 was considered. Everolimus/exemestane had an incremental benefit of 11.88 QAPFW (0.22 QAPFY) compared to exemestane and an incremental cost of $60,574. This translated into an ICER of $265,498.5/QAPFY. Univariate sensitivity analyses showed important variations of the ICER, ranging between $189,836.4 and $530,947/QAPFY. A tornado analysis suggested that the key drivers of our model, by order of importance, included health utility value for stable disease, everolimus acquisition costs, and transition probabilities from the stable to the progression states. The Monte-Carlo simulation showed results that were similar to the base-case analysis. This cost-effectiveness analysis showed that everolimus plus exemestane is not cost-effective compared to exemestane alone. Further research is needed to investigate the cost-effectiveness of the drug combination within sub-groups of the population studied in BOLERO-2.

Original languageEnglish (US)
Pages (from-to)433-441
Number of pages9
JournalBreast Cancer Research and Treatment
Volume147
Issue number2
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Fingerprint

exemestane
Cost-Benefit Analysis
Hormones
Breast Neoplasms
Gross Domestic Product
Disease-Free Survival
Costs and Cost Analysis
Tornadoes
Therapeutics
Fee Schedules
Aromatase Inhibitors
Drug Combinations
United States Food and Drug Administration
Medicare
Population Groups
Everolimus

Keywords

  • Analysis
  • Aromatase inhibitor therapy
  • BOLERO-2
  • Cost-effectiveness
  • Everolimus
  • Exemestane
  • Health-related quality of life
  • Metastatic breast cancer
  • Progression-free survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Cost-effectiveness analysis of everolimus plus exemestane versus exemestane alone for treatment of hormone receptor positive metastatic breast cancer. / Diaby, Vakaramoko; Adunlin, Georges; Zeichner, Simon B.; Avancha, Kiran; Lopes, Gilberto; Gluck, Stefan; Montero, Alberto J.

In: Breast Cancer Research and Treatment, Vol. 147, No. 2, 01.09.2014, p. 433-441.

Research output: Contribution to journalArticle

Diaby, Vakaramoko ; Adunlin, Georges ; Zeichner, Simon B. ; Avancha, Kiran ; Lopes, Gilberto ; Gluck, Stefan ; Montero, Alberto J. / Cost-effectiveness analysis of everolimus plus exemestane versus exemestane alone for treatment of hormone receptor positive metastatic breast cancer. In: Breast Cancer Research and Treatment. 2014 ; Vol. 147, No. 2. pp. 433-441.
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