Cost-benefit evaluation of advanced therapy lines in metastatic triple-negative breast cancer in Germany

Amelie Wickmann; Melina Sophie Kurte; Julia Jeck; Luisa Camacho; Dennis Klinkhammer; Florian Kron; Robert Dengler

doi:10.1186/s12962-024-00528-1

Cost-benefit evaluation of advanced therapy lines in metastatic triple-negative breast cancer in Germany

Cost Eff Resour Alloc. 2024 Mar 8;22(1):21. doi: 10.1186/s12962-024-00528-1.

Authors

Amelie Wickmann^#¹, Melina Sophie Kurte^#^{1

2}, Julia Jeck³, Luisa Camacho¹, Dennis Klinkhammer⁴, Florian Kron^#^{1

3

5

4}, Robert Dengler^#⁶

Affiliations

¹ VITIS Healthcare Group, Cologne, Germany.
² Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
³ Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
⁴ FOM University of Applied Sciences, Essen, Germany.
⁵ Faculty of Medicine, Center for Integrated Oncology (CIO ABCD), University of Cologne, University Hospital Cologne, Cologne, Germany.
⁶ Oncologic Healthcare Consulting GbR, Munich, Germany. info@onkologieberatung.de.

^# Contributed equally.

Abstract

Background: Triple-negative breast cancer (TNBC) is responsible for 10-20% cases of breast cancer and is resulting in rising healthcare costs. Thus, health-economic evaluations are needed to relate clinical outcomes and costs of treatment options and to provide recommendations of action from a health-economic perspective.

Methods: We investigated the cost-benefit-ratio of approved treatment options in metastatic TNBC in Germany by applying the efficiency frontier approach. These included sacituzumab-govitecan (SG), eribulin, vinorelbine, and capecitabine. Clinical benefit was measured as (i) median overall survival (mOS) and (ii) health-related quality of life (HRQoL) in terms of time to symptom worsening (TSW). To assess medical benefits, literature was systematically reviewed in PubMed for (i) and (ii), respectively. Treatment costs were calculated considering annual direct outpatient treatment costs from a statutory healthcare payer perspective. It was intended that both, (i) and (ii), yield an efficiency frontier.

Results: Annual direct outpatient treatment costs amounted to EUR 176,415.21 (SG), EUR 47,414.14 (eribulin), EUR 13,711.35 (vinorelbine), and EUR 3,718.84 (capecitabine). Systematic literature review of (i) and statistical analysis resulted in OS values of 14.3, 9.56, 9.44, and 7.46 months, respectively. Capecitabine, vinorelbine, and SG are part of the efficiency frontier including OS. The highest additional benefit per additional cost was determined for vinorelbine, followed by SG. Systematic review of (ii) revealed that no TSW data of TNBC patients receiving vinorelbine were available, preventing the presentation of an efficiency frontier including HRQoL.

Conclusions: Vinorelbine is most cost-effective, followed by SG. Health-economic evaluations support decision-makers to assess treatment options within one indication area. In Germany, the efficiency frontier can provide decision support for the pricing of innovative interventions. Results of our analysis may thus guide reimbursement determination.

Keywords: Capecitabine; Efficiency frontier; Eribulin; Health-related quality of life; Sacituzumab-govitecan; Triple-negative breast cancer; Vinorelbine.