Pharmacoeconomic Evaluation Of Everolimus Plus Exemestane In The Treatment Of Advanced Breast Cancer

Objective: Given the high disease burden of breast cancer,economic evaluations of therapeutic regimens can provide economic advice for clinical medication and are significant to promote the rational utilization of healthcare resources in China.This study aimed to evaluate the economics of everolimus plus exemestane in the treatment of advanced breast cancer from the perspective of payer.Methods: A Markov model including responsive/stable state,progressive state and death was developed,with a cycle length of one month.Data from the BOLERO-2 clinical trial was used to estimate transition probabilities.Subsequently,the disease progression of hormone receptor-positive patients with advanced breast cancer was simulated over a10-year time horizon.Direct medical costs were collected to evaluate cost-effectiveness of exemestane-everolimus combination versus exemestane.In addition,one-way sensitivity analysis and probability sensitivity analysis were used to investigate the influence of parameteruncertainty on the results of the model.Results: Obtained by Markov model,the median progression-free survival(PFS)of exemestane-everolimus combination group and exemestane group were 7.9 months and 3.2 months,respectively.In the BOLERO-2 clinical trial,the median PFS were 7.8 months in the exemestane-everolimus combination group and 3.2 months in the exemestane group.Furthermore,the baseline analysis showed that the incremental cost effectiveness ratio(ICER)for exemestane-everolimus combination group to exemestane group was 587 442 yuan per quality-adjusted life year(QALY),which was higher than the willingness-to-pay(WTP)threshold(161 940 China yuan,CNY/QALY).The health utility of responsive/stable state in exemestane-everolimus combination group had the greatest influence on ICER in the one-way sensitivity analysis.However,the ICER was always higher than WTP threshold with the change of variables.In the probability sensitivity analysis,exemestane-everolimus combination appeared to be less cost-effective than exemestane at the threshold of WTP of 161 940 CNY.The probability of exemestane-everolimus combination being cost-effective was more than 50% when the WTP threshold was more than 600 000 CNY per QALY.Conclusion: Compared with exemestane monotherapy,using everolimus plus exemestane might not be cost-effective in patients withhormone receptor positive advanced breast cancer.Therefore,the patients’ economic conditions and their own wishes should be considered when making treatment decision in clinical practice.Besides,lowering the price of everolimus or incorporating it into the medical insurance catalogue could lessen the economic burden of patients and may be a practicable way to improve the economics of everolimus plus exemestane.For clinical pharmacists,enhancing medication adherence,managing adverse drug reactions,and exploring new biomarkers may be potential interventions to improve the cost-effectiveness of combination of everolimus and exemestane.