Cost-Effectiveness of Margetuximab vs Trastuzumab for ERBB2–Positive, Advanced Breast Cancer

Under a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted life year (QALY), margetuximab plus chemotherapy is not cost-effective compared to trastuzumab plus chemotherapy for patients with ERBB2–positive, advanced breast cancer (Clin Breast Cancer. 2022;S1526-8209(22)00063-5. doi:10.1016/j.clbc.2022.03.002).

“In the international, randomized, open-label, phase 3 SOPHIA trial, margetuximab plus chemotherapy showed improved progression-free survival (PFS), and overall survival (OS) compared with trastuzumab plus chemotherapy,” wrote Mingyang Feng, Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, and coauthors.

This analysis aimed to examine whether margetuximab is cost-effective compared to trastuzumab, both in combination with chemotherapy, in pretreated patients with ERBB2–positive, advanced breast cancer.

Researchers developed a 3-state Markov model using clinical data from the SOPHIA trial. Costs and utilization were derived from the standard fee database or previously published literature and estimated from the US payer perspective. One-way and probabilistic sensitivity analyses were conducted, as well as a subgroup analysis to evaluate whether margetuximab is cost-effective in patients carrying a CD16A-158F allele.

Margetuximab plus chemotherapy provided an incremental 0.04 QALYs and incremental cost of $66,109.78 compared to trastuzumab plus chemotherapy, resulting in an incremental cost-effectiveness ratio (ICER) of $1,486,442.35 per QALY. In the subgroup of patients carrying a CD16A-158F allele, he ICER decreased to $592,669.73 per QALY.

The most influential factors in the sensitivity analysis were PFS state, costs of margetuximab, and utility of progressive disease state.

“Under current WTP threshold, margetuximab plus chemotherapy is not cost-effective compared with trastuzumab plus chemotherapy in pretreated patients with ERBB2-positive advanced breast cancer,” concluded Dr Feg and colleagues.

“Selecting CD16A-158F allele carriers might be a considerable option to optimize the cost-effectiveness of margetuximab,” they added