Trastuzumab with carboplatin/paclitaxel for treatment of advanced stage and recurrent uterine papillary serous carcinoma: A cost-effectiveness analysis

Objective. Uterine papillary serous carcinoma (UPSC) is a variant of endometrial cancer that is aggressive and associated with poor outcomes. We sought to evaluate the cost effectiveness of carboplatin/paclitaxel alone versus carboplatin/paclitaxel with trastuzumab among patients with Her2/neupositive advanced or recurrent UPSC. Methods. We designed a Markov model in TreeAge Pro 2019 software to simulate management of a theoretical cohort of 4000 patients with Her2/neu-positive advanced or recurrent uterine papillary serous carcinoma (UPSC) followed for four years. In the carboplatin/paclitaxel with trastuzumab strategy, we included the cost of testing for Her2/neu status. We obtained all model inputs from the literature and a societal perspective was assumed. Outcomes induded progression-free survival, progression, UPSC-specific mortality, cost, and quality-adjusted life years (QALYs). The intervention was considered cost effective if the incremental cost-effectiveness ratio (ICER) was below the willingness-to-pay threshold of $100,000 per QALY. Sensitivity analyses were used to determine the robustness of the results. Results. In our theoretical cohort of 4000 women, treatment with the addition of trastuzumab resulted in 637 fewer deaths and 627 fewer cases of progression compared with treatment with carboplatin/paclitaxel alone. Treatment with trastuzumab was associated with an additional cost of S144,335,895, but was associated with an increase of 2065 QALYs. The ICER was $69,903 per QALY, which was below our willingness-to-pay threshold. Sensitivity analysis demonstrated that this treatment strategy was costeffective until the cost of 6 months of treatment surpassed $38,505 (baseline input: $27,562). Conclusion. We found that the addition of trastuzumab to carboplatin/paditaxel was a cost-effective treatment strategy for patients with advanced/recurrent Her2/neu-positive UPSC. (C) 2020 Elsevier Inc All rights reserved.

Automated summary

The study evaluated the cost effectiveness of carboplatin/paclitaxel with trastuzumab versus carboplatin/paclitaxel alone in patients with Her2/neu-positive advanced or recurrent UPSC. The addition of trastuzumab was associated with fewer deaths and progression cases, with an increase in cost but also an increase in QALYs. The intervention was considered cost effective with an ICER below the willingness-to-pay threshold.