An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer

  • Anagha GogateEmail author
  • Jason S. Rotter
  • Justin G. Trogdon
  • Ke Meng
  • Christopher D. Baggett
  • Katherine E. Reeder-Hayes
  • Stephanie B. Wheeler



The goal of this systematic review is to provide an update to the review by Pouwels et al. by conducting a systematic review and an assessment of the reporting quality of the economic analyses conducted since 2014.


This systematic review identified published articles focused on metastatic breast cancer treatment using the Medline/PubMed and Scopus databases and the following search criteria: (((cost effectiveness[MeSH Terms]) OR (cost effectiveness) OR (cost-effectiveness) OR (cost utility) OR (cost–utility) OR (economic evaluation)) AND ((“metastatic breast cancer”) OR (“advanced breast cancer”))). The reporting quality of the included articles was evaluated using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.


Of the 256 identified articles, 67 of the articles were published after October 2014 when the prior systematic review stopped its assessment (Pouwels et al. in Breast Cancer Res Treat 165:485–498, 2017). From the 67 articles, we narrowed down to include 17 original health economic analyses specific to metastatic or advanced breast cancer. These articles were diverse with respect to methods employed and interventions included.


Although each of the articles contributed their own analytic strengths and limitations, the overall quality of the studies was moderate. The review demonstrated that the vast majority of the reported incremental cost-effectiveness ratios exceeded the typically employed willingness to pay thresholds used in each country of analysis. Only three of the reviewed articles studied chemotherapies rather than treatments targeting either HER2 or hormone receptors, demonstrating a gap in the literature.


Systematic review Metastatic breast cancer Cost-effectiveness 



This work was supported, in part, by the Centers for Disease Control and Prevention and National Cancer Institute Special Interest Project entitled “Economic Burden of Metastatic Breast Cancer across the Life Course” (3-U48-DP005017-04S4, PIs: Trogdon and Wheeler) and by the Cancer Information and Population Health Resource, UNC Lineberger Comprehensive Cancer Center, with funding provided by the University Cancer Research Fund via the state of North Carolina.

Compliance with ethical standards

Conflict of interest

AG held an internship position with Janssen Pharmaceuticals, Inc. for work external to this study. JT received research funding to his institution from Merck, Inc. for another project. SW receives grant funding to their institution from Pfizer. JR, CB, KRH, and KM do not have any conflicts of interest to disclose.

Informed consent

For this type of study formal consent is not required.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anagha Gogate
    • 1
    Email author return OK on get
  • Jason S. Rotter
    • 1
  • Justin G. Trogdon
    • 1
    • 2
  • Ke Meng
    • 2
  • Christopher D. Baggett
    • 2
    • 3
  • Katherine E. Reeder-Hayes
    • 2
    • 4
  • Stephanie B. Wheeler
    • 1
    • 2
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  3. 3.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  4. 4.Division of Hematology/OncologyUniversity of North CarolinaChapel HillUSA

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