Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2– advanced or metastatic breast cancer in Spain

Abstract

PurposeThe aim of this study was to evaluate the cost-effectiveness of ribociclib compared to palbociclib, both in combination with letrozole, in the first-line treatment of postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer (ABC) from the perspective of the Spanish National Health System (NHS).Patients and methodsDisease progression was simulated with a partitioned survival model developed from the parameterization and extrapolation of survival curves of postmenopausal women with HR+/HER2− ABC from clinical trials with ribociclib or palbociclib, both in combination with letrozole. The model was structured on the basis of three health states (progression-free, progressed disease, and death), with a 1-month cycle length and inclusion of subsequent treatments administered for disease progression, over a time horizon of 15 years. Clinical, economic, and quality of life parameters were drawn from clinical trials and the literature. The use of resources and clinical practice in the Spanish setting was validated by a panel of experts. The Spanish NHS perspective was adopted, taking into account exclusively direct health costs from 2017 expressed in Euros. Drug prices used were the reported ex-factory prices. Uncertainty of the parameters and robustness of the results were evaluated using deterministic and probabilistic sensitivity analyses (2,000 iterations).ResultsThis cost-effectiveness analysis showed a greater benefit (0.437 and 0.285 life-years gained [LYGs] and quality-adjusted life years [QALYs] gained, respectively) and a slightly higher cost (€439.86) for ribociclib+letrozole compared to palbociclib+letrozole. The resulting incremental cost-effectiveness and cost-utility ratios were €1,007.69 per LYG and €1,543.62 per QALY gained, respectively. The results of the multiple sensitivity analyses showed limited dispersion of the outcomes, thus corroborating their robustness.ConclusionFrom the NHS perspective, considering the most commonly established willingness-to-pay thresholds in the Spanish setting, ribociclib+letrozole would represent a cost-effective therapeutic option compared to palbociclib+letrozole in the first-line treatment of HR+/HER2− ABC in postmenopausal women.

Cost‐effectiveness of ribociclib as initial treatment for premenopausal women with advanced breast cancer in Singapore

“…Our results are comparable with overseas cost‐effectiveness studies which found palbociclib or ribociclib were not cost‐effective in the first‐line setting, with ICERs ranging between USD100,000‐770 000/QALY 9‐13 . We did not compare the cost‐effectiveness of ribociclib with other CDK4/6 inhibitors but several studies have reported that ribociclib is either cost‐saving or cost‐effective compared to palbociclib 12,33 . Of note, as none of the phase 3, first‐line CDK4/6 inhibitor studies have reported mature OS results, all published CEAs were either based on immature OS data or data from, a small phase 2 trial which did not show an OS benefit.…”

“…[9][10][11][12][13] We did not compare the cost-effectiveness of ribociclib with other CDK4/6 inhibitors but several studies have reported that ribociclib is either cost-saving or cost-effective compared to palbociclib. 12,33 Of note, as none of the phase 3, first-line CDK4/6 inhibitor studies have reported mature OS results, all published CEAs were either based on immature OS data or data from, a small phase 2 trial which did not show an OS benefit.…”

Cost-effectiveness analysis of atezolizumab in advanced triple-negative breast cancer

“…Utilities of 0.715 and 0.443 were used for the PF and PD states, respectively, based on a primary utility study by Lloyd et al 14 The choice of this study was consistent with prior economic analyses. [15][16][17][18] Disutilities due to adverse events (AEs) were not included in the model as the reported differences in incidences of AEs between the two treatment groups were not considered significant enough to result in differences in quality of life.…”

Cost-effectiveness analysis of atezolizumab in advanced triple-negative breast cancer

“…number of LYs) to produce the outcome of QALYs in the model. Utilities of 0.715 and 0.443 were used for the PF and PD states, respectively, based on a primary utility study by Lloyd et al [18] The choice of this study was consistent with prior economic analyses [19][20][21][22]. Disutilities due to adverse events (AEs) were not included in the model as the reported differences in incidences of AEs between the two treatment groups were not considered significant enough to result in differences in quality of life.…”