乳腺癌（BC）是女性最常见的恶性肿瘤之一。此外，人表皮生长因子受体2阳性（HER2+）乳腺癌在25%的乳腺癌患者中过度表达，导致预后不佳的困境。尽管已建立了一线和二线治疗，但HER2+转移性乳腺癌（mBC）的最佳三线治疗仍存在争议。因此，本研究从支付者的角度分析了奈拉替尼加卡培他滨（N+C）和拉帕替尼加卡培他滨（L+C）在为期5年的时间范围内的成本效益。建立了半周期修正的四状态Markov模型，以模拟N+C和L+C药物治疗患者的BC事件和死亡过程。该模型的数据来自NCT01808573试验和其他已发表的文献。进行了一种确定性敏感性分析（DSA），以调查变量的影响，并基于二阶蒙特卡洛模拟进行了概率敏感性分析（PSA）。此外，进行了亚组分析以验证其在中国的成本效益。基准情景结果显示，在82.70%的生成情景中，N+C处于支配地位，与L+C相比，提高了0.17个QALY（质量调整生命年）并减少了$1,861.28。ICER为$ -1,3294.86/QALY，未超过愿意支付（WTP）阈值，而在亚组中，ICER降至$ -2,448.17/QALY。这项分析表明，奈拉替尼加卡培他滨与拉帕替尼加卡培他滨相比，在继续或在二线HER2靶向治疗期间进展的HER2+ mBC患者中，可能具有成本效益。因此，奈拉替尼加卡培他滨可以成为第三线治疗选择。版权所有 © 2023 Ren, Ren, Zheng, Yang and Xu.

Breast cancer (BC) is one of the most common malignant tumors in women. In addition, human epidermal growth factor receptor 2-positive (HER2+) BC is overexpressed in 25% of BC patients, resulting in the predicament of poor prognosis. Although first- and second-line treatments have been established, optimum third-line treatment is still mired in controversies for HER2+ metastatic BC (mBC). Therefore, this study analyzes the cost-effectiveness of neratinib plus capecitabine (N+C) and lapatinib plus capecitabine (L+C) over a 5-year time horizon from a payer perspective.A half-cycle corrected four-state Markov model was established to simulate the course of BC events and deaths in N+C and L+C armed patients. The data of this model were derived from NCT01808573 trail and other published literatures. One-way deterministic sensitivity analysis (DSA) was conducted to investigate the impact of variables and probabilistic sensitivity analysis (PSA) was performed based on second-order Monte Carlo simulation. In addition, subgroup analysis was performed to verify its cost-effectiveness in China.The base-case results found that N+C was in dominant position in 82.70% of the generation scenarios, providing an improvement of 0.17 quality-adjusted life-years (QALYs) and a reduction of $1,861.28 compared with L+C. The ICER was $-1,3294.86/QALY, which did not exceed the willingness to pay (WTP) threshold, while in subgroup, the ICER decreased to $-2,448.17/QALY.This analysis indicated that the combination of neratinib plus capecitabine is likely to be cost-effective in comparison with lapatinib plus capecitabine in patients with HER2+ mBC who continues to progress during or after second-line HER2-targeted therapy. So neratinib plus capecitabine can become a third-line treatment option.Copyright © 2023 Ren, Ren, Zheng, Yang and Xu.