337P - Efficiency frontier analysis (EFA) of metastatic breast cancer (mBC) treatments: a UK perspective

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Breast Cancer, Metastatic
Presenter Chakkarin Burudpakdee
Authors C. Burudpakdee1, D. Bertwistle2
  • 1Health Economics And Outcomes Research, IMS Health, Philadelphia/US
  • 2Health Economics & Outcomes Research, IMS Health, N1 9JY - London/UK



As newer therapies for mBC become available, understanding the efficiency of these therapies will be important for HTA recommendations and treatment decisions. EFA may be a useful method of assessing the efficiency of newer interventions. The EFA displays the outlay (cost) and gains with technologies, and displays the next most efficient option going forward. This study was designed to evaluate whether EFA could be useful in identifying the efficiency of mBC therapies adopted by the NHS, and to identify the efficiency frontier for newer technologies.


A literature search was performed to identify mBC treatments that underwent HTA in the UK. Reports were reviewed to identify treatment efficacy and HTA recommendations. Costs were determined for a course of treatment. The incremental costs per patient were plotted on the horizontal axis and incremental median overall survival (ΔOS) of each treatment was plotted on the vertical axis to construct the EFA line. Treatments below this line are considered inefficient options. Treatments above this line have better OS and may redefine the efficiency frontier. Treatments in the upper right quadrant beyond the frontier line are in an area where ceiling price has not been defined. Treatments in the lower right quadrant beyond the frontier line are inefficient due to higher cost for lower OS.


Ten reports that evaluated efficacy in terms of median OS were included in the EFA. The therapies are paclitaxel albumin, gemcitabine, trastuzumab, bevacizumab, lapatinib, eribulin and fulvestrant. On the frontier line are paclitaxel albumin (ΔOS of 2.3 months at £2020), gemcitabine (ΔOS of 2.8 months at £6020), and trastuzumab (ΔOS of 4 months at £16939); all received positive recommendations. Lapatinib (ΔOS of 1.9 months at £10180), bevacizumab (ΔOS of 1.7 months at £36560), eribulin (ΔOS of 2.5 months at £4834) and fulvestrant (ΔOS of 2.3 months at £2481) are all below the frontier line and received negative recommendations.


EFA may be a useful method for assessing the efficiency of new mBC treatment options for clinical use. Further studies are needed to better understand value in terms of efficiency of treatments in other tumor types and disease areas.


All authors have declared no conflicts of interest.