Cost-effectiveness of datopotamab deruxtecan versus chemotherapy as a first-line treatment for patients with advanced triple-negative breast cancer
Abstract
BackgroundThe phase III TROPION-Breast02 trial demonstrated improved progression-free and overall survival with datopotamab deruxtecan (Dato-DXd) versus chemotherapy in patients with previously untreated advanced triple-negative breast cancer who were ineligible for immunotherapy. This study evaluated the cost-effectiveness of Dato-DXd from the perspectives of the United States (U.S.) and Chinese healthcare systems.MethodsA three-state partitioned survival model was developed using TROPION-Breast02 data, with a 10-year horizon and 21-day cycles. Costs and utilities were obtained from public databases and published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life-year (QALY) gained. Willingness-to-pay thresholds were $150,000/QALY in the U.S. and $27,906/QALY in China. Sensitivity and scenario analyses assessed uncertainty and the robustness of the findings, and exploratory subgroup analyses were performed.ResultsCompared with chemotherapy, Dato-DXd increased costs by $565,572.29 and QALYs by 0.44 in the U.S., yielding an ICER of $1,287,001.65/QALY. In China, the corresponding increases were $39,052.50 and 0.42 QALYs, yielding an ICER of $92,640.82/QALY. Price reductions of approximately 62.43% in the U.S. and 28.83% in China were required to reach the respective cost-effectiveness thresholds. Progression-free survival utility and Dato-DXd price were the most influential parameters in one-way sensitivity analyses. In exploratory scenario analyses, limiting treatment duration to the reported median yielded cost-effective results in both countries. Assuming unchanged efficacy, a hypothetical reduction in the Dato-DXd dose from 6 to 4 mg/kg made it cost-effective in China but not in the U.S. Exploratory subgroup analyses yielded conclusions consistent with the base-case findings.ConclusionAt the modeled prices and under the base-case assumptions, Dato-DXd was not cost-effective compared with chemotherapy in either country. Price reductions could improve its cost-effectiveness. Results were sensitive to assumptions about treatment duration. The potential economic benefits of reduced-dose or fixed-duration strategies depend on clinical confirmation of maintained efficacy and acceptable safety.
Related
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BibTeX
@article{xiang2026costeffectiveness,
title = {{Cost-effectiveness of datopotamab deruxtecan versus chemotherapy as a first-line treatment for patients with advanced triple-negative breast cancer}},
author = {Zuojuan Xiang and Qiao Xia and Zhengxiong Li},
journal = {Frontiers in Pharmacology},
year = {2026},
month = nov,
doi = {10.3389/fphar.2026.1965457},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1965457},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of datopotamab deruxtecan versus chemotherapy as a first-line treatment for patients with advanced triple-negative breast cancer
AU - Zuojuan Xiang
AU - Qiao Xia
AU - Zhengxiong Li
PY - 2026
DA - 2026/11/06
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1965457
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1965457
AB - BackgroundThe phase III TROPION-Breast02 trial demonstrated improved progression-free and overall survival with datopotamab deruxtecan (Dato-DXd) versus chemotherapy in patients with previously untreated advanced triple-negative breast cancer who were ineligible for immunotherapy. This study evaluated the cost-effectiveness of Dato-DXd from the perspectives of the United States (U.S.) and Chinese healthcare systems.MethodsA three-state partitioned survival model was developed using TROPION-Breast02 data, with a 10-year horizon and 21-day cycles. Costs and utilities were obtained from public databases and published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life-year (QALY) gained. Willingness-to-pay thresholds were $150,000/QALY in the U.S. and $27,906/QALY in China. Sensitivity and scenario analyses assessed uncertainty and the robustness of the findings, and exploratory subgroup analyses were performed.ResultsCompared with chemotherapy, Dato-DXd increased costs by $565,572.29 and QALYs by 0.44 in the U.S., yielding an ICER of $1,287,001.65/QALY. In China, the corresponding increases were $39,052.50 and 0.42 QALYs, yielding an ICER of $92,640.82/QALY. Price reductions of approximately 62.43% in the U.S. and 28.83% in China were required to reach the respective cost-effectiveness thresholds. Progression-free survival utility and Dato-DXd price were the most influential parameters in one-way sensitivity analyses. In exploratory scenario analyses, limiting treatment duration to the reported median yielded cost-effective results in both countries. Assuming unchanged efficacy, a hypothetical reduction in the Dato-DXd dose from 6 to 4 mg/kg made it cost-effective in China but not in the U.S. Exploratory subgroup analyses yielded conclusions consistent with the base-case findings.ConclusionAt the modeled prices and under the base-case assumptions, Dato-DXd was not cost-effective compared with chemotherapy in either country. Price reductions could improve its cost-effectiveness. Results were sensitive to assumptions about treatment duration. The potential economic benefits of reduced-dose or fixed-duration strategies depend on clinical confirmation of maintained efficacy and acceptable safety.
SN - 1663-9812
ER -