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Cost-effectiveness of the addition of CDK4/6 inhibitors to standard endocrine therapy in first-line treatment of women with advanced HR+/HER2− breast cancer in Mexico

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Abstract

Purpose

To estimate the cost-effectiveness of adding a CDK4/6 inhibitor to standard endocrine therapy in the first-line setting for advanced HR+/HER2− breast cancer in postmenopausal and premenopausal women, from the perspective of the Mexican public healthcare system.

Methods

We used a partitioned survival model to simulate relevant health outcomes in a synthetic cohort of patients with breast cancer derived from the PALOMA-2, MONALEESA-2, MONARCH-3 trials for postmenopausal patients, and from the MONALEESA-7 study for premenopausal patients. Effectiveness was measured in life years gained. Cost-effectiveness is reported through incremental cost-effectiveness ratios (ICER).

Results

In postmenopausal patients, palbociclib led to an increase of 1.51 life years, ribociclib of 1.58 years, and abemaciclib of 1.75 years, compared to letrozole alone. The ICER was 36,648 USD, 32,422 USD, and 26,888 USD, respectively. In premenopausal patients, ribociclib led to an increase of 1.82 life years when added to goserelin and endocrine therapy, with an ICER of 44,579 USD. In the cost minimization analysis, for postmenopausal patients, ribociclib was the treatment with the highest costs due to follow-up requirements.

Conclusion

Palbociclib, ribociclib, and abemaciclib demonstrated a significant increase in effectiveness in postmenopausal patients, and ribociclib in premenopausal patients, when added to standard endocrine therapy for patients with advanced HR+/HER2− breast cancer. At the national stablished willingness to pay, only the addition of abemaciclib to standard endocrine therapy in postmenopausal women would be considered cost-effective. However, differences on results between therapies for postmenopausal patients were not statistically significant.

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Data availability

Source data is available upon request to the corresponding author.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Instituto Nacional de Salud Pública, Cuernavaca, México

    Mariana Molina-Jaimes, Antonio Galindo-González & Sergio Bautista-Arredondo

  2. Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México

    Haydeé Cristina Verduzco-Aguirre

  3. Secretaría de Salud, Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, México

    Gustavo Reyes-Terán

  4. Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México

    Enrique Soto-Perez-de-Celis

Authors
  1. Mariana Molina-Jaimes
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  2. Antonio Galindo-González
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  3. Haydeé Cristina Verduzco-Aguirre
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  4. Sergio Bautista-Arredondo
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  5. Gustavo Reyes-Terán
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  6. Enrique Soto-Perez-de-Celis
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Mariana Molina-Jaimes, Antonio Galindo-González, and Sergio Bautista-Arredondo. The first draft of the manuscript was written by Mariana Molina-Jaimes and Haydeé Cristina Verduzco-Aguirre and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Enrique Soto-Perez-de-Celis.

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The authors have no relevant financial or non-financial interests to disclose.

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This study did not involve human or animal subjects.

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Molina-Jaimes, M., Galindo-González, A., Verduzco-Aguirre, H.C. et al. Cost-effectiveness of the addition of CDK4/6 inhibitors to standard endocrine therapy in first-line treatment of women with advanced HR+/HER2− breast cancer in Mexico. Clin Transl Oncol 26, 239–244 (2024). https://doi.org/10.1007/s12094-023-03247-w

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  • DOI: https://doi.org/10.1007/s12094-023-03247-w

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