Cost-effectiveness of ribociclib plus letrozole<i>versus</i>palbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic breast cancer: a Brazilian private payer perspective

Buehler, Anna Maria; Castilho, Gabriela; Dionne, Pierre; Stefani, Stephen

doi:10.1177/17588359211000593

Cited by 7 publications

(5 citation statements)

References 54 publications

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“…Ribociclib was more cost-effective than abemaciclib and palbociclib for postmenopausal women with HR+/HER2– advanced breast cancer in Brazil. 48,49 In Mexico, only abemaciclib was found to be cost-effective among CDK4/6 inhibitors for HR+/HER2– advanced breast cancer. 50 A recent study found the addition of ribociclib or palbociclib to fulvestrant for HR+/HER2– metastatic breast cancer to be cost-ineffective in India.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Sra,

Sasi,

Batra

et al. 2024

JCO Glob Oncol

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PURPOSE Incorporating adjuvant cyclin-dependent kinase (CDK) 4/6 inhibitors abemaciclib and ribociclib along with endocrine therapy has been shown to improve invasive disease-free survival (iDFS) for hormone receptor–positive (HR+) human epidermal receptor 2–negative (HER2–) early breast cancer (EBC). This study assesses the cost-effectiveness of this strategy, along with adjuvant aromatase inhibitors from an Indian perspective. METHODS A Markov chain model evaluated the cost-effectiveness of abemaciclib and ribociclib with letrozole compared with letrozole alone for HR+/HER2– EBC from a payer perspective in India. Key measures included lifetime quality-adjusted life-years (QALY), life-years (LY), and total costs. This study explores two scenarios for effectiveness: a best-case (BC) scenario, where the benefit of CDK4/6 inhibitors in improving iDFS lasts a lifetime, and a worst-case (WC) scenario, where benefits disappear after 5 years. Probabilistic sensitivity analyses (PSA) were used to account for simulation uncertainty. RESULTS In the BC scenario, abemaciclib added 2.17 QALY and 4.96 LY, incurring ₹2,317,957.7 ($27,756.65 in US dollars [USD]) in additional costs. However, the incremental cost-effectiveness ratio (ICER) for abemaciclib exceeded India's willingness-to-pay threshold in the BC and WC scenarios. In the BC scenario, ribociclib added 0.98 QALY and 2.58 LY with added costs of ₹1,711,504.32 ($20,494.6 USD). The ICER for ribociclib also surpassed India's threshold in both scenarios. PSA showed that neither drug was cost-effective at the current market prices in either BC/WC scenario. The cost of abemaciclib and ribociclib needs to be reduced by at least 78.61% and 87.19%, respectively, to be cost-effective in the BC scenario. CONCLUSION The combination of adjuvant abemaciclib or ribociclib with letrozole is not cost-effective for HR+/HER2– EBC in India in either the BC or WC scenario.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Sra,

Sasi,

Batra

et al. 2024

JCO Glob Oncol

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“…It was found that in HR+ BC patients, the downstream HR signaling pathway in tumor tissue of PPBC patients was more similar to the pathway of HR negative BC patients ( 37 , 38 ). Therefore, further studies should be conducted to identify potential therapeutic strategies for PPBC by combining existing efficacy evaluations and outcome data, and to determine whether existing agents, such as CDK4/6 inhibitors, can reverse resistance to HR+ PPBC endocrine therapy ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…More recently, cyclin-dependent kinase (CDK) 4/6 inhibitors have come into widespread use in the treatment of HR+/HER2− BC patients ( 12 ). CDK4/6 inhibitors represent a paradigm shift in the treatment of advanced BC HR+/HER2−, given the clinically and statistically significant gain in overall survival associated with this new class of medications ( 13 ). However, the report on the application and efficacy of CDK4/6 inhibitors in HR+ PPBC patients is still blank.…”

Section: Introductionmentioning

confidence: 99%

A rapid reduction in tumor size by cyclin-dependent kinase inhibition in hormone receptor-positive postpartum breast cancer: a case report of two patients and a review of the literature

Han¹,

Wang²,

Li³

et al. 2022

Ann Transl Med

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Background: Postpartum breast cancer (PPBC) as an independent entity different from PABC. PPBC is defined as breast cancer (BC) diagnosed within 5 years after delivery in many relevant literatures and is associated with a poor prognosis and a decrease in overall survival. PPBC patients commonly present with inflammatory breast cancer (IBC) phenotype, multifocal lesions, and lymph node metastasis. Hormone receptor-positive (HR+) PPBC is an under-investigated subtype. In PPBC, the risk of death of HR+ subtype significantly increased two-fold, while that was only modestly increased for triple-negative breast cancer (TNBC) subtype, and was not significant in human epidermal growth factor receptor 2-positive (HER2+) subtype. HR+ PPBC is a subtype associating with enhanced signatures of cell cycle control, T-cell activation and exhaustion, decreased HR signaling, and altered P53 signaling. The recommended treatment for HR+ PPBC patients is still lacking. Cyclin-dependent kinase (CDK) 4/6 inhibitors are used as a novel treatment standard not only in pretreated patients but also in the first-line setting of HR+ metastatic breast cancer (MBC). However, there is no clinical case report on the application and efficacy of CDK4/6 inhibitors in HR+ PPBC patients.Case Description: This article describes the clinical cases of two patients with advanced HR+ PPBC who were rapidly relieved after receiving leuprorelin combined with letrozole combined with dalpiciclib. We reviewed the related literature of PPBC, and found that HR+ PPBC has not been clinically classified as a BC subtype, and only some basic studies suggested that HR+ PPBC may be sensitive to CDK4/6 inhibitors.The purpose of this study is to provide the basis for the related research on the therapeutic effect of CDK4/6 inhibitors in HR+ PPBC through the report of clinical cases.Conclusions: This article reports for the first time the good therapeutic effects of CDK4/6 inhibitors on HR+ PPBC patients. Based on our findings, we suggest that dalpiciclib combined with endocrine therapy can be considered as the first-line treatment for patients with advanced HR+ PPBC. Our case report provides new clinical evidence for the related research on the role of CDK4/6 inhibitors in HR+ PPBC therapy.

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“…ANS also uses HTA for incorporation decisions, and cost-effectiveness studies conducted from the perspective of the private health care system were an important criterion in that decision-making. 29 Providing access to these innovations only for patients in the private health care system will exacerbate the differences between both health care systems, thus increasing inequity in BC treatment. Lack of access to CDK4/6 inhibitors in the public setting represents an important gap to be filled, considering the recognized importance of benefits to patients with BC.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a Brazilian public health care system perspective

Rosa

Magliano²,

Simon

et al. 2022

Ther Adv Med Oncol

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Introduction: The MONALEESA-7 trial compared ribociclib plus endocrine therapy (ET) with placebo as first-line treatment of advanced luminal/HER2-negative breast cancer (ABC) in premenopausal and perimenopausal women (age <50 years) and showed significant benefits to progression-free survival and overall survival. This study aimed to compare the cost-effectiveness of ribociclib + ET versus ET alone in patients with ABC from the perspective of the Brazilian public national health system. Methods: We calculated the incremental cost-effectiveness ratio (ICER) using a Markov model with progression-free survival, post-progression survival, and death states. We expressed ICER as incremental costs per progression-free life-year (PFLY) and quality-adjusted life-year (QALY) gained in a 10-year time horizon. We used parametric survival distributions fit to MONALEESA-7 data to generate survival distributions for progression-free and post-progression survival. The largest British preference study in breast cancer served as the basis to estimate health-state utilities. We estimated direct costs (ABC treatment, follow-up, monitoring, and adverse events) using Brazilian-specific values from public sources. An expert consensus panel determined the resource patterns required. We applied annual discounts of 5% to costs and QALYs. Results: Ribociclib + ET resulted in an incremental gain of 1.03 PFLYs and 0.80 QALYs at a cost of $37,319.31. The ICER of ribociclib + ET versus ET was $36,379.41 per PFLY gained and $46,590.79 per QALY gained. In deterministic sensitivity analysis, results were primarily affected by the annual discount rate, followed by the cost of ribociclib. In probabilistic sensitivity analysis, simulations agreed with the base-case. Conclusion: Ribociclib increased PFLYs and QALYs in patients with HR+/HER2− ABC when added to ET. Because Brazil does not have a formally defined cost-effectiveness threshold, other domains need to be considered for incorporation decisions, such as disease burden and humanistic impact on this young, economically active population. These findings may be useful in discussions for incorporation of ribociclib into the Brazilian public health system.

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Cost-effectiveness of ribociclib plus letrozoleversuspalbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic breast cancer: a Brazilian private payer perspective

Cited by 7 publications

References 54 publications

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

A rapid reduction in tumor size by cyclin-dependent kinase inhibition in hormone receptor-positive postpartum breast cancer: a case report of two patients and a review of the literature

Cost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a Brazilian public health care system perspective

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