Cost-Effectiveness of Ribociclib plus Letrozole Versus Palbociclib plus Letrozole and Letrozole Monotherapy in the First-Line Treatment of Postmenopausal Women with HR+/HER2- Advanced or Metastatic Breast Cancer: A U.S. Payer Perspective

Mistry, Rohit; May, J.; Suri, Gaurav; Young, Kate; Brixner, Diana I.; Oderda, Gary M.; Biskupiak, Joseph; Tang, Derek; Bhattacharyya, S.; Mishra, Dinesh Kumar; Bhattacharyya, Devarshi; Dalal, Anand A.

doi:10.18553/jmcp.2018.24.6.514

Cited by 53 publications

(78 citation statements)

References 30 publications

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“…Our findings on the drug acquisition costs are broadly consistent with three studies conducted in the USA and the UK that found that the major component of the pharmaceutical therapy costs is the CDKi treatment. 31–33 The main driver of ADR costs was found to be the haematological adverse events, an outcome that is congruent with the findings of a study assessing the cost-effectiveness of palbociclib or ribociclib in the treatment of advanced HR-positive, HER2 breast cancer in the USA. 33 …”

Section: Discussionsupporting

confidence: 71%

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Real-world clinical outcome and toxicity data and economic aspects in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy: the experience of the Hellenic Cooperative Oncology Group

et al. 2020

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BackgroundWe evaluated real-world clinical outcomes and toxicity data and assessed treatment-related costs in patients with advanced breast cancer who received treatment with cyclin-dependent kinase inhibitors (CDKi).Patients and methodsWe conducted a prospective–retrospective analysis of patients with advanced hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who received a CDKi, in combination with endocrine therapy, at any line of treatment. The primary endpoint was progression-free survival (PFS). Cost analysis was conducted from a public third-payer (National Organization for Healthcare Services Provision (EOPYY)) perspective, assessing only costs related to direct medical care, including drug therapy costs and adverse drug reaction (ADR)-related costs.ResultsFrom July 2015 to October 2019, 365 women received endocrine therapy combined with CDKi; median age was 61 years, postmenopausal 290 (80.6%) patients. CDKi were administered as first-line treatment in 149 (40.9%) patients, second-line treatment in 96 (26.4%) and third-line treatment and beyond in 119 (32.7%) patients. The most common adverse events were neutropenia, anaemia, thrombocytopenia and fatigue. Grade 3–4 adverse events occurred in 86 (23.6%) patients, whereas 8 (2.2%) patients permanently discontinued treatment due to toxicity. The median PFS for patients who received CDKi as first-line, second-line and third-line treatment and beyond was 18.7, 12 and 7.4 months, respectively. The median overall survival since the initiation of CDKi treatment was 29.9 months (95% CI: 23.0–not yet reached (NR)). The mean pharmaceutical therapy cost estimated per cycle was 2 724.12 € for each patient, whereas the main driver of the ADR-related costs was haematological adverse events.ConclusionsTreatment with CDKi was well tolerated, with a low drug discontinuation rate. Patients who received CDKi as first-line treatment had improved PFS and OS compared with second-line treatment and beyond. The main component of direct medical costs assessed in the cost analysis comprises CDKi pharmaceutical therapy costs.Trial registration numberNCT04133207

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Section: Discussionsupporting

confidence: 71%

“…The economic burden to payers associated with the acute treatment of these adverse events was calculated based on the Diagnostic-Related Groups tariff issued by the MoH ( online supplementary table 1 ). 31 …”

Section: Methodsmentioning

confidence: 99%

Real-world clinical outcome and toxicity data and economic aspects in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy: the experience of the Hellenic Cooperative Oncology Group

et al. 2020

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“…We used a standard AUC, 6 mg/mL/min, and assumed male sex, 65 years old, body weight, 70-kg, height, 178-cm, body surface area, 1.84 m 2 , and serum creatinine, 1 ( 23 ). The price was derived from the Centers for Medicare & Medicaid Services and published articles, and the details were demonstrated in Table 1 and Supplementary Table 3 ( 24 – 26 , 31 – 33 ). The costs of radiographic examination covered computed tomography (CT) (every 6 weeks after treatment and every 9 weeks after progression) ( 32 ).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab vs. Chemotherapy as First-Line Therapy in Advanced Non-Small Cell Lung Cancer

She

Liao

et al. 2020

Front. Oncol.

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Background: The CheckMate 227 trial has indicated that nivolumab plus ipilimumab compared with chemotherapy significantly increases long-term survival in the first-line setting of advanced non-small-cell lung cancer (NSCLC). Methods: A Markov model was built to estimate the cost and effectiveness of nivolumab plus ipilimumab vs. chemotherapy as the first-line therapy in patients with advanced NSCLC based on outcomes data from the CheckMate 227 trial. We calculated the cost and health outcomes at a willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) in populations with different programmed death ligand 1 (PD-L1) expression levels (≥50, ≥1, and <1%) or a high tumor mutational burden (TMB) (≥10 mutations per megabase). Sensitivity analysis were used to test the model stability.

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“…The costs of AEs were based on the published literature [21,[26][27][28][29]. The follow-up costs covered fees for computed tomography [30] (baseline estimate; week 12; every 6 weeks in first 45 months; every 12 weeks thereafter) and laboratory evaluations [31] (regularly throughout the treatment period and for 30 days thereafter). Costs were adjusted to present 2019 U.S. dollars, and the U.S. Consumer Price Index was adopted as a reference for inflation.…”

Section: Utility and Cost Estimatesmentioning

confidence: 99%

Cost-Effectiveness of Pembrolizumab plus Axitinib Versus Sunitinib as First-Line Therapy in Advanced Renal Cell Carcinoma in the U.S.

Ding

Hu²,

Yin

et al. 2020

The Oncologist

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Background. The data from the phase III clinical trial KEYNOTE-426 indicated that pembrolizumab plus axitinib compared with sunitinib could generate clinical benefits in patients with previously untreated advanced renal cell carcinoma (RCC). Given the incremental clinical benefits, we examined the potential cost-effectiveness of pembrolizumab plus axitinib versus sunitinib in the first-line setting for patients with advanced RCC from the U.S. payers' perspective. Materials and Methods. Cost and health outcomes were estimated at a willingness-to-pay (WTP) threshold of $100,000 to $150,000 per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters, and additional subgroup analyses were performed as well. Results. Upon our analyses, the total treatment costs in the pembrolizumab plus axitinib and sunitinib groups were $522,796 and $348,424 and the QALYs gained 2.90 and 1.72, respectively. In the base-case analysis, compared with receiving sunitinib, patients with advanced RCC receiving pembrolizumab plus axitinib gained 1.18 more QALYs at an incremental cost-effectiveness ratio of $148,676/QALY. The results of subgroup analyses demonstrated that pembrolizumab plus axitinib was most cost-effective for patients who had one organ with metastasis. Conclusion.

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Cost-Effectiveness of Ribociclib plus Letrozole Versus Palbociclib plus Letrozole and Letrozole Monotherapy in the First-Line Treatment of Postmenopausal Women with HR+/HER2- Advanced or Metastatic Breast Cancer: A U.S. Payer Perspective

Cited by 53 publications

References 30 publications

Real-world clinical outcome and toxicity data and economic aspects in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy: the experience of the Hellenic Cooperative Oncology Group

Real-world clinical outcome and toxicity data and economic aspects in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy: the experience of the Hellenic Cooperative Oncology Group

Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab vs. Chemotherapy as First-Line Therapy in Advanced Non-Small Cell Lung Cancer

Cost-Effectiveness of Pembrolizumab plus Axitinib Versus Sunitinib as First-Line Therapy in Advanced Renal Cell Carcinoma in the U.S.

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