French bean counters weigh herceptin vs lapatinib

[Lani]

BUT THEY DON"T understand that the two drugs are not equivalent!!!!!!



J Med Econ. 2012 Sep 12. [Epub ahead of print]
Budget impact analysis of the use of oral and intravenous anticancer drugs for the treatment of HER2-positive metastatic breast cancer.
Benjamin L, Buthion V, Iskedjian M, Farah B, Rioufol C, Vidal-Trécan G.
Abstract
Abstract Objectives: This study aimed at comparing the budgetary impact of two anticancer drugs currently approved for the treatment of HER2-positive metastatic breast cancer (MBC) from the French Health Insurance perspective: trastuzumab-based therapy (TBT) administered intravenously and lapatinib, a self-administered oral dual therapy with capecitabine (L+C) for patients who continue to progress despite TBT. Methods: A budget impact analysis was performed on a 3-year time horizon (2012-2014) to simulate a dynamic cohort of 4 182 HER2-positive patients with a progressing MBC treated with TBT (73%) and L+C (27%). The model was adjusted on progression-free survival (PFS). Office visits, clinical evaluations, drug acquisition and administration costs and transportation costs obtained from the literature and published databases were considered. Results: In the base case analysis (2012), the annual treatment cost per patient for TBT (36 570€) was two times higher than that of L+C (17 179€). Using L+C for all patients (N= 4 182) would avoid €9.7 million of drug administration and transportation costs. Hospital costs represented 1% vs. 87% while community costs represented 99% vs. 13% of L+C and TBT treatment costs, respectively. The lack of direct comparison PFS and treatment dosage modification data were the main limitations. However, no major changes from baseline results were observed from sensitivity analyses. Conclusions: Despite a slightly higher acquisition cost, the treatment cost of L+C remains lower than that of TBT and is the only approved anti-HER2 treatment for HER2-positive patients with progressing MBC. Based on this, it seems important to consider the potential savings for the Health Insurance with the use of oral drug due to the reduction of outpatient hospitalizations. Such reductions may result in a subsequent budget reduction for hospitals but may also provide those facing with acute medical activity with opportunities to better manage other diseases whose treatment cannot be externalized.
PMID: 22970840 [

[michka]

Hi Lani. Wow, what profound ignorance!
I cannot find where these guys work.
Benjamin L, Buthion V, Iskedjian M, Farah B, Rioufol C, Vidal-Trécan G
Is there any other reference in the article? I want to bring this up to the maximum of oncs and have this corrected.
In France, the oncs still decide over the "bean counters" but it may not last. Anyway, we cannot let such a report circulate.
Michka

[Lien]

Sometimes insurance companies get away with this kind of stupidity. I hope they get fired.

Also, if Insurance companies fund research, their only motive is to reduce costs in the long run, so researchers who are enjoying the funding may be tempted to come up with results that are company-friendly.

A disgrace!

Jacqueline

[sarah]

Like Michka, I'd be interested to know more also. So far everyone here with HER2 goes on it for a year, longer if it's metatastic (I was on it for 6 and they had originally talked about for life). With all the studies showing that a shorter period works just as well, I'm sure it will be shortened but haven't heard anything else. I will ask the hospital people at our next cancer support group meeting if they've heard anything but basically here, doctors are in charge of what their patients are given.
I can't imagine an oncologist wouldn't know the difference between the 2 drugs!
However I know there was great excitement about Tykerb because it attacks both HER2 and HER1 and seemed like a miraculous drug, now TDM1 seems to be that drug.
Does this mean you feel Tykerb is inferior to Herceptin?
I've only known people who progressed after being on Herceptin who were then given Tykerb and one friend got both. She had been desperate to get into the Tyberb trials when it first came out.

[Lani]

from another article two of them wrote I found this list of authors:


Iskedjian M, Iyer S, Lawrence Librach S, Wang M, Farah B, Berbari J.
Source
PharmIdeas Research and Consulting Inc. (M.I., B.F., J.B.), Oakville, Ontario, Canada; Pfizer, Inc. (S.I.), Collegeville, Pennsylvania, USA

Maybe I impuged the French--could just be Canadians!!! but the article quotd euros(?)

[Lani]

upon further investigation--I was right, they were French

Burden of breast cancer with brain metastasis: a French national hospital database analysis.
Benjamin L, Cotté FE, Mercier F, Vainchtock A, Vidal-Trécan G, Durand-Zaleski I.
J Med Econ. 2012;15(3):493-9. Epub 2012 Feb 17.
PMID: 22304337 [PubMed - indexed for MEDLINE]
Related citations

Rioufol C.
Source
Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department - Université Lyon 1, Ecole Doctorale Interdisciplinaire Sciences Santé, Lyon, France.

[sarah]

Hello Lani,
Thanks for this further info but is Tykerb not as good as Herceptin? I thought because it attacked both HER2 and HER1 it was thought to be better?
thanks as usual for your helpful info
health and happiness
sarah

[Redwolf8812]

Creepy, as some of us are deathly allergic to tykerb.

[Lani]

No, I just came back from ASCO breast conference and lapatinib is in general not as effective as herceptin, but both combined are more effective than either alone.

Lapatinib is usually given if progression occurs while on herceptin especially if the progression includes brain mets, but research seems to be showing that it is best to stay on the herceptin and just add to it--

Most additions except for AIs or chemo are only approved in clinical trials eg
mTor inhibitors, Hsp90 inhibitors, etc but neoadjuvant studies show herceptin+laptainib to be a very effective combinaiton

Hope this helps

[rhondalea]

http://informahealthcare.com/doi/abs...rchHistoryKey=

Address for correspondence: Laure Benjamin, Laboratoire GlaxoSmithKline, Pharmaco-Epidemiology and Health, Outcomes Research, 100 route de Versailles, 78163 Marly le Roi Cedex, France. Tel: +33 1 39 17 91 68; Fax: +33 1 39 17 86 00; laure.l.benjamin@gsk.com

[MJsHusband]

MJ has been on Tykerb-only treatment for the past 3 months after finishing 4 rounds of Xeloda/Tykerb. She couldn't tolerate the side-effects of Xeloda any longer than that, especially the extreme fatigue. Tomorrow she has CT/PET scans. She has had no symptoms of anything so hopefully Tykerb is doing its thing.

[phil]

Hmm, doesn't Glaxo make lapatinib ? So much for " un-biased " research. As lani said, overall, herc and t dm-1 are generally superior to tykerb.

[michka]

Thanks Lani. Now I know where they work. I am going to go after those bean counters next week. (this week is not my best week because of tdm1 infusion). Michka