Estimated Life-Years Saved in Women with HER2-Positive Metastatic Breast Cancer Receiving First-Line Trastuzumab and Pertuzumab in the United States

Value Health. 2015 Sep;18(6):876-83. doi: 10.1016/j.jval.2015.06.003. Epub 2015 Aug 13.

Abstract

Background: HER2 positive (HER2+) metastatic breast cancer (MBC) is associated with high mortality. Trastuzumab was approved for use in 1998, but the life-years saved from first-line use are unknown, as are the potential US population benefits from adding pertuzumab.

Objectives: The first aim was to estimate the number of life-years saved by using first-line trastuzumab between 1999 and 2013 in HER2+ women with MBC. In addition, based on these estimates, the second aim was to project the life-years that could be saved by adding pertuzumab to trastuzumab in first-line therapy.

Methods: We constructed a simulation model accounting for incidence, testing rates, therapy utilization, and overall survival. The model was run for 1999 to 2013 (15 years) to estimate the life-years saved from using trastuzumab plus chemotherapy instead of chemotherapy alone. The model was also run from 2013 to 2027 (15 years) to project the life-years that might be saved by adding pertuzumab. Uncertainty was incorporated using Monte-Carlo methods.

Results: The estimated number of women with HER2+ MBC varied over time, with the peak of 9700 in 2005 and the low of 7700 in 2018. The cumulative incremental life-years saved because of first-line trastuzumab use from 1999 to 2013 was estimated to be 156,413 (95% simulation interval 114,840-195,201). The projection for pertuzumab from 2013 to 2027 was 137,959 (95% simulation interval 56,011-225,069). Exploratory analyses of value showed that pertuzumab, trastuzumab, and chemotherapy is associated with a $1.10 billion gain compared with chemotherapy alone, and adding pertuzumab is associated with a $0.06 billion gain compared with trastuzumab with chemotherapy.

Conclusions: This simulation model suggests that substantial progress has been made in treating HER2+ women over the past 15 years, and the future may witness similar gains with the introduction of pertuzumab.

Keywords: breast cancer; epidemiology; life-years; pertuzumab; trastuzumab.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / economics
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / economics
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / antagonists & inhibitors*
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / economics
  • Breast Neoplasms / mortality
  • Computer Simulation
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Health Services Research
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Models, Economic
  • Models, Statistical
  • Molecular Targeted Therapy
  • Monte Carlo Method
  • Protein Kinase Inhibitors / adverse effects
  • Protein Kinase Inhibitors / economics
  • Protein Kinase Inhibitors / therapeutic use*
  • Quality-Adjusted Life Years
  • Receptor, ErbB-2 / analysis
  • Receptor, ErbB-2 / antagonists & inhibitors*
  • Time Factors
  • Trastuzumab / adverse effects
  • Trastuzumab / economics
  • Trastuzumab / therapeutic use*
  • Treatment Outcome
  • Uncertainty
  • United States / epidemiology

Substances

  • Antibodies, Monoclonal, Humanized
  • Biomarkers, Tumor
  • Protein Kinase Inhibitors
  • ERBB2 protein, human
  • Receptor, ErbB-2
  • pertuzumab
  • Trastuzumab