The CHEUAL Breast Cancer Model:Cost-Utility Analysis to Support Decision-Making Model application of Paclitaxel plus Bevacizumab in Metastatic Breast Cancer

Abstract

Introduction: Despite the important advances observed in the last years in the comprehension of the clinical nature of breast cancer and its treatment, this disease remains a significant cause of morbidity and mortality worldwide, being significantly associated with a huge burden in health budget. Objectives: To construct, validate and apply to clinical reality the CHEUAL Breast Cancer (BC) Model, in order to evaluate the cost-utility of new treatment options versus standard systemic therapy protocols (after surgery and radiotherapy, if adequate), in patients with early stage and metastatic breast cancer, from the Portuguese National Health Service (NHS), Hospital and Physician perspectives, supporting and turning easier the work of these professionals in a transparent way. The model application involves a case study for testing a new drug association of Paclitaxel plus Bevacizumab in metastatic breast cancer, through the clinical perspective. Methods: A five-Stage Markov Decision Process Matrix with twenty -month transition cycles of six-month length was developed to estimate the long-term health outcomes for patients (quality adjusted life years - QALYs) and economic consequences (incremental cost-effectiveness ratio - ICER) of implementing new therapeutica l interventions in BC. Portuguese NHS or Hospital resource use, costs and consequences were estimated from published unit costs and QALYs, respectively. Clinical and economic outcomes were discounted 5% per annum, as legislated by the INFARMED to Portuguese economic evaluation analysis. The cost per QALY ratio of the standard BC therapy was estimated and one-way sensitivity analysis was performed. Results: Considering a 120 month time horizon, the model was successfully build and validated. Paclitaxel plus bevacizumab were estimated to decrease quality-adjusted life years and to aid costs, compared to standard treatment. This therapy option correspond to an incremental cost -effectiveness ratio of 16.880,56 €/QALY per patient, if preferred. Conclusions: Our research goals had been successfully achieved. Ultimately, the CHEUAL BC model allows the identification of efficient BC management strategies and of treatments that are good value for money in a credible and efficient way. This model may be adapted to a software (and to became interactive), to other chronicle diseases (especially those with a higher budget impact) and worldwide, indicating a step towards the future, although there is still much to be done. The therapy option tested is not cost-effective, with a high degree of certainty, in the Portuguese setting.