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Objectives <p>Breast cancer stands out as a prevalent and life-threatening cancer among women, ranking as the second leading cause of cancer-related fatalities globally. Trastuzumab is a commonly employed treatment for human epidermal growth factor receptor 2 (HER2) positive advanced breast cancer. Following trastuzumab treatment failure, the Chinese Society of Clinical Oncology (CSCO) recommends lapatinib with capecitabine, pyrotinib plus capecitabine, trastuzumab emtansine (T-DM1), and trastuzumab deruxtecan (T-DXd). The study aimed to evaluate the relative cost-effectiveness of four treatment approaches for advanced breast cancer with HER2 positive status in the Chinese healthcare system.</p> Methods <p>The clinical data for this study were acquired from the following clinical trials: NCT02422199, NCT03080805, NCT00829166, and NCT03529110. Survival data were reconstructed and extrapolated using fractional polynomial (FP) models, Royston–Parmar (RP) models, and standard parametric models. A partitioned survival model with a 3-week cycle length and a 10-year time horizon was developed to estimate costs, health outcomes, and incremental cost-effectiveness ratios (ICERs). The robustness of the model was tested using one-way sensitivity analysis and probabilistic sensitivity analysis.</p> Results <p>The ICER values for pyrotinib plus capecitabine, T-DM1, and T-DXd were $59,278.37/QALY, $50,029.87/QALY, and $148,234.68/QALY, respectively, when compared to lapatinib plus capecitabine. The deterministic sensitivity analysis indicated that ICER variability was primarily driven by drug costs, patient body weight, hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), and the utilities of the progression-free (PF) and progressive disease (PD) health states. A probabilistic sensitivity analysis revealed that lapatinib’s advantage produced a stable result at the willing-to-pay (WTP) threshold.</p> Conclusion <p>In the context of the Chinese health system, none of the three alternative regimens—pyrotinib plus capecitabine, T-DM1, and T-DXd—demonstrated cost-effectiveness relative to lapatinib plus capecitabine at the current WTP threshold.</p>

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Cost-effectiveness analysis of the treatment pathway after trastuzumab treatment failure in patients with HER2-positive advanced breast cancer: a chinese health system perspective

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月18日

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  • Tianqi Zhou,
  • Yu Zhang,
  • Chenlu Li,
  • Nan Wu,
  • Zhixian Liu,
  • Jifu Wei,
  • Ning Cai,
  • Silu Xu

摘要

Objectives

Breast cancer stands out as a prevalent and life-threatening cancer among women, ranking as the second leading cause of cancer-related fatalities globally. Trastuzumab is a commonly employed treatment for human epidermal growth factor receptor 2 (HER2) positive advanced breast cancer. Following trastuzumab treatment failure, the Chinese Society of Clinical Oncology (CSCO) recommends lapatinib with capecitabine, pyrotinib plus capecitabine, trastuzumab emtansine (T-DM1), and trastuzumab deruxtecan (T-DXd). The study aimed to evaluate the relative cost-effectiveness of four treatment approaches for advanced breast cancer with HER2 positive status in the Chinese healthcare system.

Methods

The clinical data for this study were acquired from the following clinical trials: NCT02422199, NCT03080805, NCT00829166, and NCT03529110. Survival data were reconstructed and extrapolated using fractional polynomial (FP) models, Royston–Parmar (RP) models, and standard parametric models. A partitioned survival model with a 3-week cycle length and a 10-year time horizon was developed to estimate costs, health outcomes, and incremental cost-effectiveness ratios (ICERs). The robustness of the model was tested using one-way sensitivity analysis and probabilistic sensitivity analysis.

Results

The ICER values for pyrotinib plus capecitabine, T-DM1, and T-DXd were $59,278.37/QALY, $50,029.87/QALY, and $148,234.68/QALY, respectively, when compared to lapatinib plus capecitabine. The deterministic sensitivity analysis indicated that ICER variability was primarily driven by drug costs, patient body weight, hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), and the utilities of the progression-free (PF) and progressive disease (PD) health states. A probabilistic sensitivity analysis revealed that lapatinib’s advantage produced a stable result at the willing-to-pay (WTP) threshold.

Conclusion

In the context of the Chinese health system, none of the three alternative regimens—pyrotinib plus capecitabine, T-DM1, and T-DXd—demonstrated cost-effectiveness relative to lapatinib plus capecitabine at the current WTP threshold.