Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer

ZHANG Ranran; LIU Guoqiang; ZHANG Yuxi; GAO Shengnan; GAO Ning; FENG Bing; LIU Ran; LI Qian

doi:10.6039/j.issn.1001-0408.2025.15.13

您当前的位置：

首页 >

文章列表页 >

Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer

更新时间：2025-09-24

- Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer
- ZHONGGUO YAOFANG Vol. 36, Issue 15, Pages: 1893-1898(2025)
- 作者机构：
  
  1.河北医科大学第三医院临床药学部，石家庄　050051
  2.河北省药物与卫生技术综合评估学会，石家庄　050051
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.15.13
  CLC： R956;R979.1
- Received：06 April 2025，
  
  Revised：2025-07-29，
  
  Accepted：29 July 2025，
  
  Published：15 August 2025
- 稿件说明：
移动端阅览
张冉冉,刘国强,张羽曦,等.卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析[J].中国药房,2025,36(15):1893-1898.

ZHANG Ranran,LIU Guoqiang,ZHANG Yuxi,et al.Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer[J].ZHONGGUO YAOFANG,2025,36(15):1893-1898.
张冉冉,刘国强,张羽曦,等.卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析[J].中国药房,2025,36(15):1893-1898. DOI： 10.6039/j.issn.1001-0408.2025.15.13.

ZHANG Ranran,LIU Guoqiang,ZHANG Yuxi,et al.Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer[J].ZHONGGUO YAOFANG,2025,36(15):1893-1898. DOI： 10.6039/j.issn.1001-0408.2025.15.13.

摘要

目的

评估卡培他滨节拍化疗联合芳香化酶抑制剂（AI）对比单用AI一线治疗激素受体阳性（HR+）/人表皮生长因子受体2阴性（HER2－）转移性乳腺癌的经济性，为临床用药方案的选择及医疗卫生决策提供依据。

方法

基于MECCA试验构建分区生存模型，以4周为循环周期，模拟至患者终身；以总成本、质量调整生命年（QALY）和增量成本-效果比（ICER）作为模型产出指标。利用敏感性分析验证基础分析结果的稳健性，并通过情境分析考察了10年、20年、终身研究时限下两种方案的经济性。

结果

在以1倍我国2024年人均国内生产总值（GDP）为意愿支付阈值（95 749元/QALY）的前提下，使用卡培他滨节拍化疗联合AI方案的患者在获得增量效用（0.66 QALYs）的同时也需要支付更多的成本，ICER为27 684.85元/QALY。单因素敏感性分析结果显示，对ICER值影响较大的因素有成本贴现率、卡培他滨节拍化疗联合AI组药品成本、无进展生存状态效用值、随访成本和后续稳定期治疗成本。概率敏感性分析结果显示，当WTP阈值≥49 250元/QALY时，卡培他滨节拍化疗联合AI方案具有经济性的概率为100%。情境分析结果表明，卡培他滨节拍化疗联合AI方案在10年、20年、终身研究时限下均较单用AI方案更具有经济性。

结论

在以1倍我国2024年人均GDP为意愿支付阈值的前提下，与单用AI方案相比，卡培他滨节拍化疗联合AI方案一线治疗HR+/HER2－转移性乳腺癌更具有经济性。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor （AI） versus AI monotherapy as first-line treatment for hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） metastatic breast cancer， thereby providing evidence-based support for clinical therapeutic decision-making and healthcare policy formulation.

METHODS

Based on the MECCA trial， a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients’ lifetime. The model outputs included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analyses were performed to validate the robustness of base-case results， while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year， 20-year， and lifetime time horizons.

RESULTS

With the willingness-to-pay （WTP） threshold set at 1 times China’s 2024 per capita gross domestic product （GDP）（95 749 yuan/QALY）， patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility （0.66 QALYs） while incurring higher costs， with ICER of 27 684.85 yuan/QALY. Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate， drug costs of the capecitabine metronomic chemotherapy combined with AI group， utility value in the progression-free survival state， follow-up costs， and treatment costs in the subsequent stable phase. Probabilistic sensitivity analysis indicated that when the WTP threshold ≥49 250 yuan/QALY， the capecitabine metronomic chemotherapy combined with AI regimen had a 100% probability of being cost-effective. Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year， 20-year， and lifetime study horizons.

CONCLUSIONS

Under the premise that the WTP threshold is set at 1 times China’s per capita GDP in 2024， capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2－ metastatic breast cancer.

关键词

Keywords

references

BRAY F ， LAVERSANNE M ， SUNG H ， et al . Global cancer statistics 2022：GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin ， 2024 ， 74 （ 3 ）： 229 - 263 .

HAN B F ， ZHENG R S ， ZENG H M ， et al . Cancer incidence and mortality in China，2022 [J ] . J Natl Cancer Cent ， 2024 ， 4 （ 1 ）： 47 - 53 .

GIULIANO M ， SCHETTINI F ， ROGNONI C ， et al . Endocrine treatment versus chemotherapy in postmenopausal women with hormone receptor-positive，HER2-negative，metastatic breast cancer：a systematic review and network meta-analysis [J ] . Lancet Oncol ， 2019 ， 20 （ 10 ）： 1360 - 1369 .

BABCOCK A ， ALI A A ， BALKRISHNAN R ， et al . Real-world clinical and economic outcomes associated with palbociclib for HR-positive/HER2-negative metastatic breast cancer：a commentary [J ] . J Manag Care Spec Pharm ， 2020 ， 26 （ 7 ）： 826 - 831 .

HOWLADER N ， ALTEKRUSE S F ， LI C I ， et al . US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status [J ] . J Natl Cancer Inst ， 2014 ， 106 （ 5 ）： dju055 .

SHAO H Q ， ZHAO M Y ， GUAN A J ， et al . A network meta-analysis of efficacy and safety for first-line and se- cond/further-line therapies in postmenopausal women with hormone receptor-positive，HER2-negative，advanced breast cancer [J ] . BMC Med ， 2024 ， 22 （ 1 ）： 13 .

MALMSTRÖM A ， HANSEN J ， MALMBERG L ， et al . Gemcitabine and capecitabine in combination for advanced anthracycline and taxane pre-treated breast cancer patients：a phase Ⅱ study [J ] . Acta Oncol ， 2010 ， 49 （ 1 ）： 35 - 41 .

DANIELSON B ， WINGET M ， GAO Z ， et al . Palliative radiotherapy for women with breast cancer [J ] . Clin Oncol （R Coll Radiol）， 2008 ， 20 （ 7 ）： 506 - 512 .

MUNZONE E ， COLLEONI M . Clinical overview of metro- nomic chemotherapy in breast cancer [J ] . Nat Rev Clin Oncol ， 2015 ， 12 （ 11 ）： 631 - 644 .

HANAHAN D ， BERGERS G ， BERGSLAND E . Less is more，regularly：metronomic dosing of cytotoxic drugs can target tumor angiogenesis in mice [J ] . J Clin Invest ， 2000 ， 105 （ 8 ）： 1045 - 1047 .

CHEN X ， HE Y J ， FAN T ， et al . Efficacy and safety of low-dose oral etoposide combined with capecitabine for patients with postoperative metastatic breast cancer resistant to anthracycline/taxanes [J ] . Thorac Cancer ， 2025 ， 16 （ 3 ）： e70003 .

HONG R X ， XU F ， XIA W ， et al . Metronomic capecitabine plus aromatase inhibitor as initial therapy in patients with hormone receptor-positive，human epidermal growth factor receptor 2-negative metastatic breast cancer：the phase Ⅲ MECCA trial [J ] . J Clin Oncol ， 2025 ， 43 （ 11 ）： 1314 - 1324 .

刘国恩 . 中国药物经济学评价指南2020 [M ] . 北京：中国市场出版社， 2020 ： 27 - 46 .

中国抗癌协会乳腺癌专业委员会，中华医学会肿瘤学分会乳腺肿瘤学组，邵志敏 . 中国抗癌协会乳腺癌诊治指南与规范：2024年版 [J ] . 中国癌症杂志， 2023 ， 33 （ 12 ）： 1092 - 1186 .

BASCH E ， BECKER C ， ROGAK L J ， et al . Composite grading algorithm for the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events （PRO-CTCAE） [J ] . Clin Trials ， 2021 ， 18 （ 1 ）： 104 - 114 .

ZOU H M ， LAI Y F ， CHEN X W ， et al . Cost-effectiveness of camrelizumab plus rivoceranib versus sorafenib as first-line treatment of unresectable hepatocellular carcinoma [J ] . Therap Adv Gastroenterol ， 2025 ， 18 ： 17562848241310314 .

LANG Y T ， CHAI Q Q ， LIN Y ， et al . Adding capivasertib to fulvestrant in patients with hormone receptor-positive advanced breast cancer：a cost-effectiveness analysis [J ] . Front Pharmacol ， 2024 ， 15 ： 1495082 .

武亚楠，吴方，侯艳红 . 德曲妥珠单抗对比恩美曲妥珠单抗二线治疗HER2阳性转移性乳腺癌的成本-效用分析 [J ] . 中国药房， 2024 ， 35 （ 2 ）： 204 - 209 .

LI J B ， LIN Z C ， WONG M C S ， et al . A cost-effectiveness analysis of capecitabine maintenance therapy versus routine follow-up for early-stage triple-negative breast cancer patients after standard treatment from a perspective of Chinese society [J ] . BMC Med ， 2022 ， 20 （ 1 ）： 320 .

周颖玉，吴群红 . 经济学理论视角下的健康贴现率研究 [J ] . 中国卫生经济， 2023 ， 42 （ 1 ）： 1 - 3 .

KERBEL R S ， KLEMENT G ， PRITCHARD K I ， et al . Continuous low-dose anti-angiogenic/metronomic chemotherapy：from the research laboratory into the oncology clinic [J ] . Ann Oncol ， 2002 ， 13 （ 1 ）： 12 - 15 .

SHE L J ， TIAN K ， HAN J Q ， et al . Cost-effectiveness analysis of metronomic capecitabine as adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma [J ] . Front Oncol ， 2022 ， 12 ： 904372 .

李梦媛，管欣，嵇欣悦，等 . 阿贝西利、哌柏西利和瑞波西利一线治疗激素受体阳性晚期乳腺癌的成本-效用分析 [J ] . 中国药房， 2024 ， 35 （ 16 ）： 2002 - 2008 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Cost-utility analysis of tislelizumab in the treatment of locally advanced or metastatic （non-）squamous NSCLC

Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer

Pharmacoeconomic evaluation of durvalumab combined with chemotherapy as first-line therapy for advanced biliary tract cancer

Pharmacoeconomic evaluation of finerenone combined with standard regimen in the treatment of heart failure with preserved or mildly reduced ejection fraction

Cost-utility analysis of benmelstobart plus anlotinib and chemotherapy as first-line treatment for extensive-stage small cell lung cancer

Related Author

WANG Chunyan

WU Jing

SHEN Lixia

WU Yanan

WU Fang

HOU Yanhong

HUO Liman

DUAN Yangyang

Related Institution

Dept. of Pharmacy， No. Hospital of the Navy of the PLA

School of International Pharmaceutical Business， China Pharmaceutical University

School of Health Emergency Management， Tianjin University

School of Pharmacy， Hebei Medical University

Dept. of Pharmacy， the Fourth Hospital of Hebei Medical University

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰