Cost-effectiveness of Metronomic chemotherapy vs Weekly Intravenous Paclitaxel in patients with ER+/HER2-Metastatic Breast Cancer

Abstract Objective：To compare the cost-effectiveness of Metronomic Oral Vinorelbine plus Cyclophosphamide and Capecitabine(VEX) and Weekly Intravenous Paclitaxel (P) in patients with Estrogen Receptor–Positive, ERBB2-Negative Metastatic Breast Cancer (MBC). Methods：The Markov model was established to simulate the patients receiving metronomic chemotherapy (VEX regimen) and Weekly Intravenous Paclitaxel. The results of clinical trials and other published literature were comprehensively used to evaluate the cost-effectiveness ratio of the two chemotherapy regimens, and sensitivity analyses were conducted. Results：The QALYs of VEX and P regimen were 1.85 and 1.45, respectively, and the ICERs were $40 333.69/QALY and $4 152.09/QALY, respectively. In China, the total cost of VEX regimen is $74 617.32, while the total cost of P regimen is $6 020.53. The cost of P regimen is much lower than that of the VEX regimen. In addition, the VEX is more effective than the P, with higher TTF and PFS, and higher disease control rates. Sensitivity analysis shows that P regimen has a more cost-effective advantage in China. The analysis of incremental cost-effectiveness shows that with VEX as the reference group, P regimen is the preferred option. Conclusions：Compared with VEX, P regimen is more cost-effective as a first-line treatment for ER+/HER2- metastatic breast cancer from the perspective of Chinese health service system.