Cost-effectiveness analyses of breast cancer medications use in developing countries: a systematic review

Abstract

Background: Pharmacoeconomics is important for breast-cancer medications due to their high costs. To our knowledge, no systematic literature reviews of pharmacoeconomic studies for breast-cancer medication use are present in developing-countries. Objectives: To systematically review the existing cost-effectiveness studies regarding breast-cancer medication in developing-countries. Methodology: A systematic literature search was performed in PubMed, EMBASE, SCOPUS, and EconLit. Two researchers independently determined the final articles, extracted data, and evaluated their quality using the Quality of Health-Economic Studies (QHES) tool. The interclass-correlation-coefficient (ICC) was calculated to assess interrater-reliability. Data were summarized descriptively. Results: Fourteen pharmacoeconomic studies published from 2009 to 2019 were included. Thirteen used patient-life-years as their effectiveness unit, of which ten also used quality-adjusted life-years. Most of the evaluations focused on trastuzumab as a single agent or on regimens containing trastuzumab (n=10). The conclusion of cost-effectiveness varied among the studies. All the studies were of high quality (QHES score> 75). There was high interrater-reliability between the two researchers (ICC=0.76). Conclusion: In many studies included in the review, the use of breast-cancer drugs in developing countries was not cost-effective. Although this review identified various high-quality cost-effectiveness studies, more pharmacoeconomic studies for the use of recently-approved agents in different disease stages, are needed.