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BMC Medicine
Published in: BMC Medicine 1/2022

Open Access 01-12-2022 | Breast Cancer | Research article

A cost-effectiveness analysis of capecitabine maintenance therapy versus routine follow-up for early-stage triple-negative breast cancer patients after standard treatment from a perspective of Chinese society

Authors: Ji-Bin Li, Zhuo-Chen Lin, Martin C. S. Wong, Harry H. X. Wang, Mengmeng Li, Su Li

Published in: BMC Medicine | Issue 1/2022

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Abstract

Background

Capecitabine maintenance therapy is safe and efficacious for early-stage triple-negative breast cancer (TNBC) patients, but the cost-effectiveness of its long-term use has not been investigated. Here, we evaluated the cost-effectiveness of capecitabine maintenance therapy, compared with routine follow-up, in early-stage TNBC patients after standard treatment from a perspective of Chinese society.

Methods

A three-state Markov model based on the data from the SYSUCC-001 trial was constructed to estimate the cost-effectiveness of capecitabine maintenance therapy in a month cycle over a period of 30-year time horizon. A 5% annual discount rate was set for all costs and benefits. One-way and probabilistic sensitivity analyses were performed to explore the model uncertainties. The main outcomes include quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and the number needed to treat (NNT) to prevent one additional event.

Results

Compared with routine follow-up, 1-year capecitabine maintenance therapy yielded an additional 1.29 quality-adjusted life years (QALYs) at an additional cost of $3391.70, with an ICER of $2630.53 (95% CI: $1159.81–$5090.12) per QALY gained. The ICER was considerably lower than the recommended willingness-to-pay (WTP) threshold (i.e., $28,130.00 per QALY). The results were sensitive to the discount rate, drug cost, and treatment cost after relapse. Further, the NNT to prevent one additional relapse case was 29.2 (95% CI: 13.2–196.6), 16.7 (95% CI: 8.4–111.6), and 12.0 (95% CI: 5.7–82.6) at 1, 2, and 5 years, respectively.

Conclusions

One-year capecitabine maintenance therapy for early-stage TNBC after standard treatment, compared with routine follow-up, was found to be highly cost-effective with promising clinical benefits and acceptable increased costs. Real-world studies are warranted to validate our findings in the future.
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Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.PubMed
2.
Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). 2021;134(7):783–91.CrossRef
3.
Jiang D, Zhang L, Liu W, Ding Y, Yin J, Ren R, et al. Trends in cancer mortality in China from 2004 to 2018: a nationwide longitudinal study. Cancer Commun (Lond). 2021;41(10):1024–36.CrossRef
4.
Rastelli F, Biancanelli S, Falzetta A, Martignetti A, Casi C, Bascioni R, et al. Triple-negative breast cancer: current state of the art. Tumori. 2010;96(6):875–88.PubMedCrossRef
5.
Lin Y, Yin W, Yan T, Zhou L, Di G, Wu J, et al. Site-specific relapse pattern of the triple negative tumors in Chinese breast cancer patients. BMC Cancer. 2009;9:342.PubMedPubMedCentralCrossRef
6.
Agarwal G, Nanda G, Lal P, Mishra A, Agarwal A, Agrawal V, et al. Outcomes of triple-negative breast cancers (TNBC) compared with non-TNBC: does the survival vary for all stages? World J Surg. 2016;40(6):1362–72.PubMedCrossRef
7.
Yi Z, Ma F, Rong G, Guan Y, Li C, Xu B. Clinical spectrum and prognostic value of TP53 mutations in circulating tumor DNA from breast cancer patients in China. Cancer Commun (Lond). 2020;40(6):260–9.CrossRef
8.
Denkert C, Liedtke C, Tutt A, von Minckwitz G. Molecular alterations in triple-negative breast cancer-the road to new treatment strategies. Lancet. 2017;389(10087):2430–42.PubMedCrossRef
9.
10.
Natori A, Ethier JL, Amir E, Cescon DW. Capecitabine in early breast cancer: a meta-analysis of randomised controlled trials. Eur J Cancer. 2017;77:40–7.PubMedCrossRef
11.
Liu M, Fang H, Qian S. Adjuvant capecitabine for early triple-negative breast cancer: a meta-analysis of randomized controlled trials. Asian J Surg. 2022;45(9):1748–50.PubMedCrossRef
12.
Masuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–59.PubMedCrossRef
13.
Lluch A, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, et al. Phase III trial of adjuvant capecitabine after standard neo-/adjuvant chemotherapy in patients with early triple-negative breast cancer (GEICAM/2003-11_CIBOMA/2004-01). J Clin Oncol. 2020;38(3):203–13.PubMedCrossRef
14.
Wang X, Wang SS, Huang H, Cai L, Zhao L, Peng RJ, et al. Effect of capecitabine maintenance therapy using lower dosage and higher frequency vs observation on disease-free survival among patients with early-stage triple-negative breast cancer who had received standard treatment: the SYSUCC-001 randomized clinical trial. JAMA. 2021;325(1):50–8.PubMedCrossRef
15.
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American cancer society/American society of clinical oncology breast cancer survivorship care guideline. CA Cancer J Clin. 2016;66(1):43–73.PubMedCrossRef
16.
Zhou W, Cao Y, Gou P, Zeng X, Hu X, Lin Z, et al. Additional adjuvant capecitabine in early breast cancer patients: a meta-analysis of randomized controlled trials. Future Oncol. 2021;17(35):4993–5002.PubMedCrossRef
17.
Liao M, Jiang Q, Hu H, Han J, She L, Yao L, et al. Cost-effectiveness analysis of utidelone plus capecitabine for metastatic breast cancer in China. J Med Econ. 2019;22(6):584–92.PubMedCrossRef
18.
Hougaard JL, Osterdal LP, Yu Y. The Chinese healthcare system: structure, problems and challenges. Appl Health Econ Health Policy. 2011;9(1):1–13.PubMedCrossRef
19.
WHO Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development / report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.
20.
Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, et al. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization; 2003.
21.
22.
Yong ASJ, Lim YH, Cheong MWL, Hamzah E, Teoh SL. Willingness-to-pay for cancer treatment and outcome: a systematic review. Eur J Health Econ. 2022;23(6):1037–57.PubMedCrossRef
23.
24.
Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796–7.PubMedCrossRef
25.
Edoka IP, Stacey NK. Estimating a cost-effectiveness threshold for health care decision-making in South Africa. Health Policy Plan. 2020;35(5):546–55.PubMedPubMedCentralCrossRef
26.
Lee C, Lee H, Cho H, Kim S, Choi I, Hwang YS, et al. Combination of anti-PD-L1 antibody with peptide MEL-dKLA targeting M2 tumor-associated macrophages suppresses breast cancer metastasis. Cancer Commun (Lond). 2022;42(4):345–9.CrossRef
27.
Guyot P, Ades AE, Ouwens MJ, Welton NJ. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol. 2012;12:9.PubMedPubMedCentralCrossRef
28.
Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010;363(20):1938–48.PubMedCrossRef
29.
Guven DC, Taban H, Dizdar O. Adjuvant capecitabine in triple negative breast cancer: the earlier, the better? J Oncol Pharm Pract. 2022;28(1):203–4.PubMedCrossRef
30.
Le QA, Hay JW. Cost-effectiveness analysis of lapatinib in HER-2-positive advanced breast cancer. Cancer. 2009;115(3):489–98.PubMedCrossRef
31.
Reed SD, Li Y, Anstrom KJ, Schulman KA. Cost effectiveness of ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol. 2009;27(13):2185–91.PubMedCrossRef
32.
Jones L, Hawkins N, Westwood M, Wright K, Richardson G, Riemsma R. Systematic review of the clinical effectiveness and cost-effectiveness of capecitabine (Xeloda) for locally advanced and/or metastatic breast cancer. Health Technol Assess. 2004;8(5):1–143 (iii, xiii-xvi).CrossRef
33.
Foster TS, Miller JD, Boye ME, Blieden MB, Gidwani R, Russell MW. The economic burden of metastatic breast cancer: a systematic review of literature from developed countries. Cancer Treat Rev. 2011;37(6):405–15.PubMed
34.
Chen C, Sun S, Yuan JP, Wang YH, Cao TZ, Zheng HM, et al. Characteristics of breast cancer in Central China, literature review and comparison with USA. Breast. 2016;30:208–13.PubMedCrossRef
35.
World health statistics. monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2021. p. 2021.
36.
Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II good practices task force. Value Health. 2022;25(1):10–31.PubMedCrossRef
37.
Ishak KJ, Kreif N, Benedict A, Muszbek N. Overview of parametric survival analysis for health-economic applications. Pharmacoeconomics. 2013;31(8):663–75.PubMedCrossRef
38.
Latimer NR. Survival analysis for economic evaluations alongside clinical trials–extrapolation with patient-level data: inconsistencies, limitations, and a practical guide. Med Decis Making. 2013;33(6):743–54.PubMedCrossRef
39.
Black WC, Nease RF Jr, Welch HG. Determining transition probabilities from mortality rates and autopsy findings. Med Decis Making. 1997;17(1):87–93.PubMedCrossRef
40.
Diaby V, Adunlin G, Montero AJ. Survival modeling for the estimation of transition probabilities in model-based economic evaluations in the absence of individual patient data: a tutorial. Pharmacoeconomics. 2014;32(2):101–8.PubMedCrossRef
41.
National Bureau of Statistics. China population and employment statistics tearbook-2020. Beijing: China Statistics Press; 2020.
42.
Wu Q, Liao W, Zhang M, Huang J, Zhang P, Li Q. Cost-effectiveness of tucatinib in human epidermal growth factor receptor 2-positive metastatic breast cancer from the US and Chinese perspectives. Front Oncol. 2020;10:1336.PubMedPubMedCentralCrossRef
43.
Durkee BY, Qian Y, Pollom EL, King MT, Dudley SA, Shaffer JL, et al. Cost-effectiveness of pertuzumab in human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2016;34(9):902–9.PubMedCrossRef
44.
45.
Weng X, Huang X, Li H, Lin S, Rao X, Guo X, et al. First-line treatment with atezolizumab plus nab-paclitaxel for advanced triple-negative breast cancer: a cost-effectiveness analysis. Am J Clin Oncol. 2020;43(5):340–8.PubMedCrossRef
46.
Yang Q, Zhong X, Zhang W, Luo T, He P, Zheng H. Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China. BMC Cancer. 2021;21(1):107.PubMedPubMedCentralCrossRef
47.
Haacker M, Hallett TB, Atun R. On discount rates for economic evaluations in global health. Health Policy Plan. 2020;35(1):107–14.PubMed
48.
van Nuland M, Vreman RA, Ten Ham RMT, de Vries Schultink AHM, Rosing H, Schellens JHM, et al. Cost-effectiveness of monitoring endoxifen levels in breast cancer patients adjuvantly treated with tamoxifen. Breast Cancer Res Treat. 2018;172(1):143–50.PubMedPubMedCentralCrossRef
49.
50.
Xin W, Ding H, Fang Q, Zheng X, Tong Y, Xu G, et al. Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial. BMJ Open. 2020;10(12): e038867.PubMedPubMedCentralCrossRef
51.
Bertram MY, Lauer JA, De Joncheere K, Edejer T, Hutubessy R, Kieny MP, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925–30.PubMedPubMedCentralCrossRef
52.
53.
Zhang Z, Ambrogi F, Bokov AF, Gu H, de Beurs E, Eskaf K. Estimate risk difference and number needed to treat in survival analysis. Ann Transl Med. 2018;6(7):120.PubMedPubMedCentralCrossRef
Metadata
Title
A cost-effectiveness analysis of capecitabine maintenance therapy versus routine follow-up for early-stage triple-negative breast cancer patients after standard treatment from a perspective of Chinese society
Authors
Ji-Bin Li
Zhuo-Chen Lin
Martin C. S. Wong
Harry H. X. Wang
Mengmeng Li
Su Li
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2022
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-022-02516-9

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