Economic evaluation of eribulin in the treatment of triple negative breast cancer in the United Kingdom

Abstract

Background: Eribulin is indicated in the European Union for patients with locally advanced or metastatic breast cancer after ≤1 prior chemotherapy for advanced disease, including an anthracycline and a taxane. The license is based on clinical trials which included patients with triple negative breast cancer (TNBC). We sought to evaluate clinical and cost‐effectiveness of eribulin in this population using decision analytic modelling. Methods: Data on OS, PFS and TTD from TNBC patients from two randomized open label studies of eribulin, 305 (NCT00388726) and 301 (NCT00337103), were pooled (N=352). The comparators were TPC (any single‐agent chemotherapy, hormonal or biological treatment; radiotherapy; or symptomatic treatment alone) (305) and capecitabine (301). A partitioned survival model developed for the National Institute for Health and Clinical Excellence submission based on pooled Kaplan‐Meier data, accounting for tumour objective response and adverse events with health‐state specific utilities mapped from QLQC30 data from study 301 was used. Lifetime horizon with discount rate of 3.5% for costs and quality‐adjusted life years (QALYs) was applied. Threshold analysis was based on 2017 UK costs and reimbursement decision criteria. Results: Use of eribulin versus the pooled comparator of capecitabine or TPC was associated with greater mean overall survival (16.00 vs 12.38 months) and progression‐free survival (4.4 vs 3.6 months) with 0.3 life years (LYs) gained and 0.2 incremental QALYs. 77% of LYs and 75% of QALYs were gained in progressive disease. Using UK end of life criteria and considering the patient access scheme price, eribulin falls well within the cost‐effectiveness threshold of £50,000/QALY and would be considered cost‐effective in the UK setting. The results were sensitive to price of eribulin, utility in the progressive disease state, discount rates and drug administration costs. Conclusions: Eribulin is cost‐effective in the treatment of patients with TNBC after ≤1 prior chemotherapy for advanced disease, including an anthracycline and a taxane in the UK.