Cost-effectiveness analysis of neratinib plus capecitabine against lapatinib plus capecitabine for HER2-Positive metastatic breast cancer

Abstract Background Neratinib plus capecitabine(N + C)has a good effect for HER2-positive metastatic breast cancer (MBC), but considering these tradeoffs in quality of life and cost, the optimal choice of treatment sequencing is unclear. Cost-effectiveness analysis can clearly quantify such tradeoffs to make more informed decisions. Our objective was to evaluate the social cost-effectiveness of the N + C regimen for HER2 positive MBC. METHODS Clinical data were extracted from a randomized controlled trial, NALA (NCT01808573). Patients were randomized into the N + C group or the lapatinib plus capecitabine (L + C) group. A Markov model was established with a 21-day cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). RESULTS In the main analysis, the QALY in N + C is 0.04492 higher than that in L + C (N + C, 0.62954 QALY; L + C, 0.58462 QALY). The ICER between N + C and L + C was − 1,796,801.93 CNY/QALY. In the subanalysis, the QALY in N + C is 0.05643 higher than that in L + C (N + C, 0.65047 QALY; L + C, 0.59404 QALY) in the Asian group. The ICER between N + C and L + C was − 1,584,528.96 CNY/QALY. Sensitivity analyses indicated the stability of the model and the impact of utility. CONCLUSION N + C was cost-effective compared with L + C for HER2 positive MBC.