Systematic Review: Economic Evaluation of Treatment for Human Epithelial Growth Factor Receptor 2-positive Metastatic Breast Cancer from a National Health Insurance Perspective

Abstract

Gita Miranda Warsito, Dewi Susanna*, Popy Yuniar

Background: Economic evaluation is often held from the societal perspective. Even it is important, as the therapy affects greatly to the patients’ life in society, economic evaluation from the payer perspective, is as important as it may help National Health Insurance (NHI) as the payer avert budget deficit as was observed in Indonesia. Unfortunately economic evaluation from the payer’s perspective is very rare to be done. This article compiles and reviews research articles of economic evaluation of therapy for human epithelial growth factor receptor 2-positive metastatic Breast Cancer (mBC) as an alternative to trastuzumab therapy, which has recently been removed from Indonesia’s National Health Insurance coverage. Methods: The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and PICO methodology (Population, Intervention, Comparison, and Outcome). Relevant articles were retrieved from online biomedical databases Scopus, PubMed, ScienceDirect, and SAGE Journals. Quality appraisal was performed using a standardized checklist which consisted of items in the CHEC checklist. Results: A total of six articles pertaining to economic evaluation of therapy for HER2-positive mBC from the NHI perspective (period: 2008–2018) were reviewed. Trastuzumab+chemotherapy showed the longest overall survival (OS, 37.8 months) with Progression-free Survival (PFS) of 12.7 months. Trastuzumab+docetaxel as 1st line therapy were associated with the longest PFS (19 months) with a total cost of US$ 12,732. With respect to therapy sequence, 1st line, trastuzumab+pertuzumab+docetaxel; 2nd line, trastuzumab+emtansine ; and 3rd line, lapatinib+capecitabine was associated with the highest quality-adjusted life year (QALY; 1.81) but also the highest total cost and incremental cost (US$360,880 and US$197,250, respectively). The sequence of 1st line, trastuzumab/docetaxel; 2nd line, T-DM1; and 3rd line, trastuzumab/lapatinib was associated the lowest QALY (1.27) but was the most cost-effective (total cost: $158,293). Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy were associated with the lowest total cost (US$3,190). Conclusion: Lapatinib+capecitabine as 2nd line therapy and exemestane monotherapy show potential as alternatives to trastuzumab therapy for HER-2 positive mBC.