Cost-Effectiveness of Pyrotinib Plus Capecitabine versus Lapatinib Plus Capecitabine for the Treatment of HER2-Positive Metastatic Breast Cancer in China: A Scenario Analysis of Health Insurance Coverage

Yuwen Bao, Zhuolin Zhang, Xuan He, Lele Cai, Xiao Wang, Xin Li, Yuwen Bao, Zhuolin Zhang, Xuan He, Lele Cai, Xiao Wang, Xin Li

Abstract

Background: The overexpression of the human epidermal growth factor receptor-2 (HER2) gene is present in 20~25% of breast cancer (BC) patients, contributing to an inferior prognosis. Recent clinical trials showed that pyrotinib has promising antitumor activities and acceptable tolerability for those patients (ClinicalTrials.gov, NCT03080805 and NCT02422199). Therefore, this study aims to assess the cost-effectiveness of pyrotinib plus capecitabine versus lapatinib plus capecitabine for patients with HER2-positive metastatic BC after prior trastuzumab.

Methods: A lifetime-partitioned survival model was established to evaluate health and economic outcomes with different treatment strategies. The primary outcome was the incremental cost-effectiveness ratio (ICER). Data were derived from the published literature, clinical trials, expert opinions, and other local charges. Sensitivity analyses were performed to assess the robustness of the findings. Scenario analyses were developed to make further evaluations.

Results: The pyrotinib regimen had significant advantages over the lapatinib regimen after enrolling in the National Reimbursement Drug List (NRDL), with cost savings of USD 15,599.27 and a gain of 0.53 QALYs. Meanwhile, before enrolling in NRDL, the pyrotinib regimen afforded the same QALYs at a higher incremental cost of USD 45,400.64 versus the lapatinib regimen, producing an ICER of USD 85,944.79 per QALY. Scenario analyses yielded similar results. Sensitivity analyses suggested stability in the cost-effectiveness findings.

Conclusions: Compared to lapatinib plus capecitabine, the pyrotinib plus capecitabine enrolled in NRDL is a cost-effective alternative second-line treatment for patients with HER2-positive metastatic BC in China.

Keywords: cost-effectiveness; health insurance coverage; lapatinib; metastatic breast cancer; partitioned survival model; pyrotinib.

Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure A1
Figure A1
ICER Scatter plot. (a) ICER Scatter plot of pyrotinib-A plus capecitabine versus lapatinib plus capecitabine; (b) ICER Scatter plot of pyrotinib-B plus capecitabine versus lapatinib plus capecitabine. Abbreviations: ICER, Incremental cost-effectiveness ratio; pyrotinib-A, pyrotinib before being enrolled in the National Reimbursement Drug List; pyrotinib-B, pyrotinib after being enrolled in the National Reimbursement Drug List.
Figure 1
Figure 1
Partitioned survival model for HER2-positive metastatic breast cancer patients. Abbreviations: PFS, progression-free survival; PD, progressive disease; HER2, human epidermal growth factor receptor 2.
Figure 2
Figure 2
Kaplan–Meier Curve and Lognormal-estimated progression-free survival (a) and overall survival (b) with pyrotinib plus capecitabine and lapatinib plus capecitabine. Abbreviations: PYR, pyrotinib; LAP, lapatinib.
Figure 3
Figure 3
Tornado diagram for one-way sensitivity analysis of pyrotinib-A plus capecitabine versus lapatinib plus capecitabine. Abbreviations: pyrotinib-A, pyrotinib before being enrolled in National Reimbursement Drug List; PFS, progression-free survival; PD, progressive disease; sub, subsequent.
Figure 4
Figure 4
Tornado diagram for one-way sensitivity analysis of pyrotinib-B plus capecitabine versus lapatinib plus capecitabine. Abbreviations: pyrotinib-B, pyrotinib after being enrolled in National Reimbursement Drug List; PFS, progression-free survival; PD, progressive disease; sub, subsequent.
Figure 5
Figure 5
Cost-effectiveness acceptability curve between pyrotinib-A plus capecitabine and lapatinib plus capecitabine. Notes: Blue line indicates pyrotinib-A regimen, and red line indicates lapatinib regimen. Abbreviations: CEAC, cost-effectiveness acceptability curve; pyrotinib-A, pyrotinib before being enrolled in National Reimbursement Drug List; QALY, quality-adjusted life-year.
Figure 6
Figure 6
Cost-effectiveness acceptability curve between pyrotinib-B plus capecitabine and lapatinib plus capecitabine. Notes: Blue line indicates pyrotinib-B regimen, and red line indicates lapatinib regimen. Abbreviations: CEAC, cost-effectiveness acceptability curve; pyrotinib-B, pyrotinib after being enrolled in National Reimbursement Drug List; QALY, quality-adjusted life-year.

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