Abstract
ObjectiveTo evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with hormone receptor positive (HR+) and human epidermal growth receptor 2 negative (HER2−) advanced breast cancer from a UK payer perspective.MethodsA cohort-based partitioned survival model was developed to evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with HR+/HER2− advanced breast cancer over a lifetime horizon. The analysis was carried out from a National Health Services and Personal Social Services perspective, and results are presented in incremental costs per quality adjusted life years. Clinical data from three randomized controlled trials (MONALEESA-2, PALOMA-1 and PALOMA-2 studies) were used, and supplemented with available real world evidence. Costs categories comprised of drug acquisition, medical management, and treatment of adverse events. Healthcare resource utilization data were identified from literature and unit costs sourced from secondary sources. Utility values were derived from MONALEESA-2 study and were supported with values identified from literature. Both deterministic and probabilistic analyses were carried out to assess uncertainty.ResultsIn the base case, treatment with ribociclib plus letrozole increased mean progression free survival (PFS) by 4.1 months and overall survival by 5.0 months compared to palbociclib plus letrozole. Further, treatment with ribociclib plus letrozole resulted in cost-savings of £8464 and incremental QALYs of 0.261, demonstrating that treatment with ribociclib plus letrozole is dominant to treatment with palbociclib plus letrozole. The probabilistic analysis also yielded mean cost-savings of £7914 and mean QALY gain of 0.273. At willingness-to-pay threshold of £30 000 per QALY, treatment with ribociclib plus letrozole had a 92% probability of being cost-effective compared to palbociclib and letrozole.ConclusionsThe results of the analysis demonstrate that ribociclib plus letrozole treatment is both cost-saving and a cost-effective option amongst the available cyclin dependent kinase 4/6 inhibitors for the treatment of post-menopausal women with advanced breast cancer. The biggest driver of the cost savings were the lower acquisition costs of ribociclib.
Highlights
Breast cancer is the most common cancer in females.[1]
Treatment with ribociclib plus letrozole was cheaper and resulted in a greater quality-adjusted life years (QALYs) compared to palbociclib plus letrozole
Dose reduction for palbociclib results in potential drug wastage that has the cost implications and was one of the drivers of the cost savings. These cost savings were due to the linear pack pricing for ribociclib compared to flat pack pricing for palbociclib; with patients moving to the lower ribociclib doses over time
Summary
Breast cancer is the most common cancer in females.[1] In the United Kingdom (UK), nearly 55 122 new cases were diagnosed in 2015 This represents about 31% of the all the new cancer cases in females.[2] Approximately 6-7% of patients are diagnosed at late stage (stage IV) and have metastases; where the tumor has spread significantly within the breast or to other organs of the body. These patients tend to have poor prognosis and a dismal one-year survival rate of 63%.3,4. With recent Food and Drug Administration (FDA) and European Medicines Agency (EMA) approval of CDK 4/6 inhibitors treatment landscape for post-menopausal women with hormone receptor positive (HR+) and human epidermal growth receptor 2 negative (HER2-) advanced breast cancer is likely to change and is going to bring about new alternatives
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
