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Old 05-20-2014, 07:44 AM   #1
'lizbeth
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Post Hey! Cost Effectiveness for our Canadian friends . . .

Adjuvant denosumab for breast cancer: What efficacy in the D-CARE trial will translate into cost effectiveness?



Abstract No:
551
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2014 ASCO Annual Meeting!


Session: Breast Cancer - HER2/ER
Type: General Poster Session
Time: Monday June 2, 8:00 AM to 11:45 AM
Location: S Hall A2
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Author(s): Nathan William Dana Lamond, Chris Skedgel, Daniel Rayson, Tallal Younis; Department of Medicine, Dalhousie University, Halifax, NS, Canada; Atlantic Clinical Cancer Research Unit, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
Abstract Disclosures

Abstract:

Background: Bone targeted agents are important therapies in the treatment of metastatic breast cancer and have a potential role in the adjuvant setting. Several trials and metaanalyses have suggested that adjuvant bisphosphonates may reduce breast cancer recurrence rates by 15% or more in postmenopausal women. Adjuvant denosumab is currently being investigated in D-CARE, an ongoing phase III trial. The aim of the current study was to estimate the absolute disease-free survival (DFS) advantage that would have to be observed in D-CARE for adjuvant denosumab to be considered cost-effective in the Canadian healthcare system. Methods: A Markov model was developed to calculate cumulative lifetime costs and quality-adjusted life year (QALY) gains for adjuvant therapy with and without denosumab in a hypothetical cohort of women with early-stage breast cancer. Costs, utilities and probabilities were derived from the literature. A one-way sensitivity analysis (SA) was performed to explore the relationship between a range of DFS hazard ratios (HR) and incremental cost-effectiveness ratios (ICER) with all other parameters held constant. Further one-way and probabilistic sensitivity analyses were performed to explore the effects of changes to other model parameters including menopausal status. The model took a direct payer perspective with all costs and benefits discounted at 3%. Results: The one-way SA showed that the ICER for adjuvant denosumab was directly related to the HR for DFS. At an ICER threshold of $100,000/QALY, the corresponding DFS HRs were 0.94 and 0.89 for pre and postmenopausal breast cancer patients, respectively. The ICER also varied with changes to other model parameters, but was stable over reasonable ranges of uncertainty. Conclusions: This model suggests that adjuvant denosumab will be considered cost-effective by current North American standards, should it reduce breast cancer recurrence rates by more than approximately 10%. In the event of positive results from D-CARE of at least this magnitude, the current anticipatory analysis may help inform treatment choices, influence drug funding decisions, and provide patients with timely access to disease-modifying therapy.
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