Introduction
Methods
Literature search and study selection
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The study population includes patients diagnosed with advanced or MBC.
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The study is a model-based economic evaluation.
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Chemotherapy or TT is included as a comparator.
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The study reports an incremental cost-effectiveness ratio (ICER) with life years (LYs) and/or quality-adjusted life years (QALYs) as measure of effect.
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The study has been published in English or Dutch as a journal article between January 2000 and October 2014.
Extraction of general information, model characteristics and outcomes
Quality assessment
Association of model characteristics with study quality and outcomes
Results
Literature search
General information and models’ characteristics of the studies
Study | Population HR and HER2 status | Country | Publication year | Treatment line (previous treatment) | Type of model | Health states | Perspective | Time horizon | Extrapolation | Cycle time | Cost categories |
---|---|---|---|---|---|---|---|---|---|---|---|
Alba et al. [8]a
| N.S. | Spain | 2013 | Second line (Anthracycline or other N.S.) | HSTM | PFD; PD; death | Health care | 5 years | Yes (Weibull) | 3 weeks | Medication, administration, monitoring, general care(health state costs), terminal phase, AEs |
Athanasakis [53]a
| HER-2+ | Greece | 2012 | First line | HSTM | PFD; PD; death | Health care | 12 years | No | 1 month | Medication, administration, supportive care, AEs |
Benedict et al. [32]a
| N.S. | UK | 2009 | Unclear/mix (Anthracycline) | HSTM | PFD; PD; death | Health care | 10 years (lifetime) | Yes (three-parameter gamma) | 3 weeks | Medication, administration, terminal phase, progression diagnosis, post-progression chemotherapy, BSC, AEs |
Brown et al. [33]a
| N.S. | UK | 2001 | Second line (Anthracycline) | HSTM | Response; PFD; PD; death | Health care | 3 years | No | 3 weeks | Medication, administration, hospitalisation, visits, monitoring, palliative medication, AEs |
Dedes et al. [34]c
| N.S. | Switzerland | 2009 | First line metastatic setting | HSTM | PFD; PD; death | Health care | Lifetime | No | 1 month | Medication, concomitant medication during chemotherapy, monitoring, disease progression, AEs |
Delea et al. [9]a
| Post-menopausal, HR+ , HER-2+ | Canada | 2013 | First line | HSTM | PFD; PD; death | Societal & Health care | 10 years | Yes (Weibull) | 1 day | Medication, administration, monitoring, pre- and post-progression, AEs, direct non-medical, indirect costs |
Delea et al. [35].a
| Post meno, HR+ , HER-2+ | UK | 2013 | First line | HSTM | PFD; PD; death | Health care | 10 years (lifetime) | Yes (Weibull) | 1 day | Medication, administration, monitoring, pre and post-progression costs, AEs |
Delea et al. [36].a
| HER-2+ | UK | 2012 | Unclear/mix (Trastuzumab) | HSTM | PFD; PD; death | Health care | 5 years (lifetime) | Yes (Weibull) | 1 day | Medication, administration, monitoring, pre and post-progression follow-up, AEs |
Elkin et al. [37].b
| HER-2+ | US | 2004 | First line | HSTM | Response; PFD; PD; death | Societal | Lifetime | No | 1 week | Medication, diagnosis, patient travel and time, visits, monitoring, progressive disease, AEs |
Frias et al. [38].a
| N.S. | Spain | 2010 | Unclear/mix (Anthracycline) | HSTM | PFD; PD; death | Health care | 5 years | Yes(three-parameter gamma) | 3 weeks | Medication, administration, progression diagnosis, best supportive care, end of life phase, AEs |
Lazzaro et al. [39].a
| N.S. | Italy | 2013 | Second line (N.R.) | HSTM | PFD; PD; death | Health care | 5 years (lifetime) | Yes (Weibull) | 3 weeks | Medication, administration, best supportive care, end of life phase, AEs |
Le et al. [40].c
| HER-2+ | US | 2009 | Second line (Anthracycline, taxane, trastuzumab) | HSTM | Response; PFD; PD; death | Societal | Lifetime | No | 1,5 month | Medication, monitoring, disease progression, AEs, patient time |
Li et al. [41].c
| N.S. | NL | 2001 | Second line (N.R.) | N.R. | Short term: Febrile Neutropenia, no Febrile Neutropenia, death; long term: response, non-response, PD, death | Health care | 1 year | No | 3 month | Medication, hospitalisation, follow-up |
Lidgren et al. [42].c
| HER-2+ | Sweden | 2008 | First line | HSTM | PFD; PD; death | Societal | N.R. | No | 1 month | Medication, visits, monitoring, diagnostics, AEs |
Lopes et al. [43].c
| N.S. | US | 2013 | Unclear/mix | Decision-tree and HSTM | Response; PFD; PD; death | Payer: Medicare | N.R. | No | 21-day | Medication, visits, monitoring |
Machado et al. [44].a
| HER-2+ | Brasil | 2012 | Unclear/mix (Trastuzumab) | HSTM | PFD; PD; death | Health care | 5 years | Yes(Weibull) | 1 month | Medication, visits, AEs |
Matter-Walstra et al. [45].b
| HER-2+ | Switzerland | 2010 | Unclear/mix (Trastuzumab) | HSTM | PFD; PD; death | Health care | Lifetime | No | 3 weeks | Drug, monitoring, progression, AEs |
Montero et al. [46].a
| N.S. | US | 2012 | First line (N.R.) | Decision-tree | Paclitaxel alone or bevacizumab + paclitaxel; further therapy and best supportive care; death | Payer | N.R. | No | N.A. | Medication, physician and administration fees, monitoring |
Norum et al. [47].c
| N.S. | Norway | 2005 | Unclear/mix (N.R.) | N.R. | N.A. | Third party payer | N.R. | No | N.A. | Medication, visits, monitoring, diagnostics, AEs |
Reed et al. [48].a
| N.S. | US | 2009 | Unclear/mix (Anthracycline) | Decision-tree | Response, PFD, PD, not determined | Health care | N.R. | No | N.A. | Medication, visits, hospitalisation, monitoring, subsequent treatment |
Refaat et al. [49].c
| HER-2- | US | 2014 | First line | HSTM | Metastatic breast cancer + Rx, bevacizumab and Rx complications, PD, death | Health care (and patient) | 5 years | No | 1 year | N.C. |
Takeda et al. [50].b
| N.S. | UK | 2007 | Second line (Anthracycline) | HSTM | Response; PFD; PD; death | Health care | Lifetime | Yes(Lognormal) | 3 weeks | Medication, visits, administration, AEs |
Verma et al. [51].c
| N.S. | Canada | 2003 | Unclear/mix (Anthracycline) | N.C. | N.A. | Health care | N.C. | No | N.A. | Medication, visits, administration, AEs |
Verma et al. [52].a
| N.S. | US | 2005 | Unclear/mix (Anthracycline) | HSTM | PFD; PD; death | Payer (and patient); health care costs considered | 2.9 years | No | 3 weeks | Medication, administration, visits, AEs |
Outcomes
Study | Intervention (regimen) | Comparator (regimen) | LYs gaineda
| QALYs gaineda
| Incremental costsb
| ICER LYb,c
| ICER QALYb,c
| INMB | ||
---|---|---|---|---|---|---|---|---|---|---|
Benedict et al. [32]. | Doc (3 wk) | – | Pac (3 week) | – | 0.53 | 0.33 | 5670 | 11,000 | 17,000 | 7530 |
Brown et al. [33]. | Doc (3 wk) | – | Pac (3 week) | – | N.R. | 0.09 | 263 | N.R. | 3000 | 3337 |
Benedict et al. [32]. | Doc (3 wk) | – | Pac (1 wk) | – | 0.47 | 0.29 | 1901 | 4000 | 6000 | 9699 |
Frias et al. [38]. | Doc (3 wk) | – | Pac (1 wk) | – | 0.37 | 0.24 | 78 | 200 | 300 | 9522 |
Benedict et al. [32].t | Doc (3 wk) | – | Nab-pac (3 wk) | – | 0.39 | 0.22 | 4521 | 12,000 | 21,000 | 4279 |
Brown et al. [33]. | Doc (3 wk) | – | Vino (1 wk) | – | N.R. | 0.25 | 5423 | N.R. | 21,000 | 4577 |
Li et al. [41]. | Doc (3 wk) | – | M (6 wk) | V (3 wk) | 0.06d
| 0.05 | 14,022 | N.R. | 279,000 | −12,022 |
Verma et al. [51]. | Cap (14,3 wk) | Doc (3 wk) | Doc (3 wk) | – | N.R. | N.R. | N.R. | 3000 | N.R. | N.C. |
Verma et al. [52]. | Cap (14, 3 wk) | Doc (3 wk) | Doc (3 wk) | – | 0.22 | 0.15 | 2067 | 9000 | 14,000 | 3933 |
Lopes et al. [43]. | Eribulin (N.S.) | – | TPC (N.S.) | – | 0.21 | 0.12 | 20,141 | 97,000 | 169,000 | −15,341 |
Lopes et al. [43]. | Eribulin (N.S.) | – | Cap (N.S.) | 0.21 | 0.12 | 15,762 | 76,000 | 132,000 | −10,962 | |
Lopes et al. [43]. | Eribulin (N.S.) | – | Nab-pac (N.S.) | 0.21 | 0.12 | 12,229 | 59,000 | 103,000 | −7429 | |
Lopes et al. [43]. | Eribulin (N.S.) | – | Doxil (N.S.) | 0.21 | 0.12 | 10,298 | 49,000 | 86,000 | −5498 | |
Lopes et al. [43]. | Eribulin (N.S.) | – | Ixa (N.S.) | 0.21 | 0.12 | 7239 | 35,000 | 61,000 | −2439 | |
Takeda et al. [50]. | Gem (1,8, 3 wk) | Pac (3 wk) | Pac (3 wk) | – | 0.32 | 0.16 | 13,743 | 43,000 | 85,000 | −7343 |
Reed et al. [48]. | Ixa (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | – | 0.17d
| 0.09 | 26,326g
| 164,000 | 306,000 | −22,726 |
Alba et al. [8]. | Nab-Pac (3 wk) | – | Pac (3 wk) | – | 0.27 | 0.16 | 3055 | 12,000 | 19,000 | 3345 |
Lazzaro et al. [39]. | Nab-Pac (3x/week) | – | Pac (3x/week) | – | N.R. | 0.17 | 2621 | N.R. | 16,000 | 4179 |
Li et al. [41]. | Pac (3 wk) | – | M (6 wk) | V (3 wk) | 0.06d
| 0.07 | 7142 | N.R. | 108,000 | −4342 |
Li et al. [41]. | Vino (1,8, 3 wk) | M (3 wk) | M (6 wk) | V (3 wk) | 0.15d
| 0.14 | 3619 | N.R. | 25,000 | 1981 |
Dedes et al. [34]. | Bev (1, and 15) | Pac (3 out of 4) | Pac (3 out of 4) | – | 0.13d
| 0.21 | 40,098 | N.R. | 188,000 | −31,698 |
Montero et al. [46]. | Bev (N.S.) | Pac (N.S.) | Pac (N.S.) | – | N.R. | 0.14 | 84,174 | N.R. | 625,000 | −78,574 |
Refaat et al. [49]. | Bev (N.S.) | Pac (N.S.) | Pac (N.S.) | – | N.R. | 0.37 | 72,127 | N.R. | 195,000 | −57,327 |
Delea et al. [36]. | Lap (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | – | 0.29 | 0.19 | 19,280 | 66,000 | 101,000 | −11,680 |
Machado et al. [44]. | Lap (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | – | 0.29 | 0.19 | 31,241 | 66,000 | 165,000 | −23,641 |
Le et al. [40]. | Lap (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | – | 0.16 | 0.12d
| 17,456 | 107,000 | 148,000 | −12,656 |
Delea et al. [36]. | Lap (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | Trast (3 wk) | 0.19 | 0.31 | −139 | N.R. | Dominant | 12,539 |
Machado et al. [44]. | Lap (14,3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | Trast (3 wk) | 0.23 | 0.13 | −10,690 | Dominant | Dominant | 15,890 |
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Let (N.S.) | – | 0.54 | 0.44 | 42,854 | 79,000 | 97,000 | −25,254e
|
Delea et al. [35]. | Lap (N.S.) | Let (N.S.) | Let (N.S.) | – | 0.58 | 0.47 | 44,219 | N.R. | 95,000 | −25,419 |
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Let (N.S.) | – | 0.54 | 0.44 | 39,572 | 73,000 | 90,000 | −21,972f
|
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | Trast (N.S.) | 0.33 | 0.24 | 3711 | 11,000 | 16,000 | 5,889e
|
Delea et al. [35]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | Trast (N.S.) | 0.74 | 0.25 | 7018 | N.R. | 28,000 | 2982 |
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | Trast (N.S.) | 0.33 | 0.24 | 1551 | 5000 | 7000 | 8,049f
|
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | – | 0.7 | 0.57 | 43,137 | 62,000 | 76,000 | −20,337e
|
Delea et al. [35]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | – | 0.35 | 0.6 | 45,821 | N.R. | 76,000 | −21,821 |
Delea et al. [9]. | Lap (N.S.) | Let (N.S.) | Ana (N.S.) | – | 0.7 | 0.57 | 38,905 | 56,000 | 69,000 | −16,105f
|
Matter-Walstra et al. [45]. | Trast (3 wk) | Cap (14,3 wk) | Cap (14,3 wk) | – | 0.58 | 0.35 | 34,013 | 58,819 | 98,424 | −20,013 |
Athanasakis [53] | Trast (3 wk) | Doc (3 wk) | Doc (3 wk) | 0.73 | 0.45 | 27,371 | 38,000 | 61,000 | −9371 | |
Norum et al. [47]. | Trast (1 wk) | – | No Trast | – | 0.3–0.7 | N.R. | 52,277 | 75,000–174,000 | N.R. | N.C. |
Elkin et al. [37]. | HercepTest, trast for 3+ | No test, chemo alone | 0.09 | 0.06 | 8,121d
| N.R. | Extendedly dominated | −5721 | ||
Elkin et al. [37]. | HercepTest, confirm 2+ with FISH, chemo and trast for FISH+ and HT+ | No test, chemo alone | 0.11 | 0.08 | 11,018d
| N.R. | Dominated | −7818 | ||
Elkin et al. [37]. | HercepTest, trast and chemo for 2+ and 3+ | No test, chemo alone | 0.11 | 0.08 | 14,517d
| N.R. | Dominated | −11,317 | ||
Elkin et al. [37]. | No test: trast, and chemo | No test, chemo alone | 0.12 | 0.09 | 36,790d
| N.R. | Dominated | −33,190 | ||
Elkin et al. [37]. | HercepTest, confirm 2+ and 3+ with FISH, chemo and trast for FISH+ | No test, chemo alone | 0.11 | 0.08 | 10,655 | N.R. | 128,000 | −7455 | ||
Elkin et al. [37]. | FISH, trast and chemo for positives | No test, chemo alone | 0.12 | 0.09 | 11,718 | N.R. | 149,000 | −8118 | ||
Lidgren et al. [42] | IHC test, trast and chemo for IHC 3+ | Chemo alone | N.R. | 0.13 | 6437 | N.R. | Extendedly dominated | −1237 | ||
Lidgren et al. [42]. | IHC test, trast and chemo for IHC 2+ and 3+ | Chemo alone | N.R. | 0.18 | 10,784 | N.R. | Dominated | −3584 | ||
Lidgren et al. [42]. | IHC test, FISH confirmation for 2+ and 3+ , trast and chemo for FISH+ | Chemo alone | N.R. | 0.18 | 8592 | N.R. | 49,000 | −1392 | ||
Lidgren et al. [42] | FISH test, trast and chemo for FISH + patients | Chemo alone | N.R. | 0.19 | 9445 | N.R. | 57,000 | −1845 |