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Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women

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Abstract

Background

In this study, we evaluate the cost and outcomes of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) plus fulvestrant, fulvestrant alone, and conventional chemotherapy as the second-line therapy for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (MBC) in India.

Methods

Using a Markov model, the clinical effectiveness of managing HR+, HER2− MBC in postmenopausal women with either a CDK4/6i (either ribociclib or palbociclib) and fulvestrant, fulvestrant alone, and chemotherapy (single-agent paclitaxel or capecitabine) was measured in terms of quality-adjusted life-years (QALYs). The costs were estimated from two different points of view: scenario I, as per the prevailing market prices of the drugs; and scenario II, as per the reimbursement rates set up by the publicly financed national health insurance scheme. Incremental cost per QALY gained with a given treatment option was compared against the next best alternative and was assessed for cost effectiveness using a threshold of 1-time the per capita gross domestic product (GDP) in India from a societal perspective.

Results

In scenario I, an MBC patient was found to incur a lifetime cost of Indian Rupees (₹) 2.54 million ($34,644), ₹2.53 million ($34,496), ₹512,598 ($6,984), ₹326,026 ($4,442) and ₹237,115 ($3,230) for the ribociclib and palbociclib combination arms, fulvestrant monotherapy, single-agent paclitaxel and the single-agent capecitabine treatment arms, respectively. The lifetime cost for CDK4/6i (ribociclib and palbociclib) combination therapy, fulvestrant monotherapy, paclitaxel, and capecitabine arms was estimated to be ₹1.94 million ($26,459), ₹1.92 million ($26,220), ₹315,387 ($4,296), ₹187,392 ($2,553) and ₹153,263 ($2,088), respectively, in scenario II. The mean QALYs lived per MBC patient with CDK4/6i (either ribociclib or palbociclib) combination therapy, fulvestrant, paclitaxel and capecitabine were estimated to be 1.4, 1.0, 0.9 and 0.7, respectively. None of the treatment arms are cost effective at current prices and reimbursement rates at a threshold of 1-time the per capita GDP of India. However, a 78% reduction in the current market price or a 72% reduction in the reimbursement rate of fulvestrant in the government-funded insurance program will make it a cost-effective treatment option for HR+, HER2− MBC patients in India.

Conclusion

CDK4/6i (ribociclib and palbociclib) therapy is not a cost-effective treatment option for MBC patients. A 72% reduction in the reimbursement rate for fulvestrant monotherapy will make it a cost-effective treatment option in the Indian context.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    Article  PubMed  Google Scholar 

  2. Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017;13(4):289–95.

    Article  PubMed  Google Scholar 

  3. India Factsheet: GLOBOCON 2020. The Global Cancer Observatory; 2021 [cited 6 Sep 2021]. Available at: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf.

  4. Agarwal G, Ramakant P. Breast cancer care in India: the current scenario and the challenges for the future. Breast Care. 2008;3(1):21–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rajan G, Culas TB, Jayalakshmy P. Estrogen and progesterone receptor status in breast cancer: a cross-sectional study of 450 women in Kerala, South India. World J Surg Oncol. 2014;12(1):120.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gennari A, Conte P, Rosso R, Orlandini C, Bruzzi P. Survival of metastatic breast carcinoma patients over a 20-year period. Cancer. 2005;104(8):1742–50.

    Article  PubMed  Google Scholar 

  7. Dafni U, Grimani I, Xyrafas A, Eleftheraki AG, Fountzilas G. Fifteen-year trends in metastatic breast cancer survival in Greece. Breast Cancer Res Treat. 2010;119(3):621–31.

    Article  CAS  PubMed  Google Scholar 

  8. Prat A, Pineda E, Adamo B, Galván P, Fernández A, Gaba L, et al. Clinical implications of the intrinsic molecular subtypes of breast cancer. Breast. 2015;24:S26-35.

    Article  PubMed  Google Scholar 

  9. Gong Y, Liu Y-R, Ji P, Hu X, Shao Z-M. Impact of molecular subtypes on metastatic breast cancer patients: a SEER population-based study. Sci Rep. 2017;7:45411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rajappa S, Bajpai J, Basade M, Ganvir M, Goswami C, Murali A, et al. Practical consensus recommendations regarding the use of hormonal therapy in metastatic breast cancer. South Asian J Cancer. 2018;7(2):137–41.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sarin R. Consensus document for management of breast cancer. Division of Publication and Information on behalf of the Secretary DHR & DG, ICMR, New Delhi. 2016. Available at: http://cancerindia.org.in/wp-content/uploads/2017/11/Breast_Cancer.pdf.

  12. National Cancer Grid—Breast Cancer. National Cancer Grid; 2017 [cited 25 Aug 2021]. Available at: https://tmc.gov.in/ncg/index.php/guidelines/search-by-cancer-type.

  13. Patel A, Tilak TVS, Gupta VG, Batra A, Mehta P, Parikh PM, et al. Dynamics of sequencing of cyclin-dependent kinase inhibitors and cost expenditure analysis in the management of metastatic hormone-receptor positive, human epidermal growth factor 2-negative advanced breast cancer. Indian J Med Paediatr Oncol. 2019;40(2):311–3.

    Article  Google Scholar 

  14. Slamon DJ, Neven P, Chia S, Fasching PA, Laurentiis MD, Im S-A, et al. Overall survival with ribociclib plus fulvestrant in advanced breast cancer. N Engl J Med. 2020;382(6):514–524 [cited 3 Dec 2020]. Available at: https://www.nejm.org/doi/10.1056/NEJMoa1911149.

  15. Turner NC, Slamon DJ, Ro J, Bondarenko I, Im S-A, Masuda N, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med. 2018;379(20):1926–36.

    Article  CAS  PubMed  Google Scholar 

  16. Sledge GW, Toi M, Neven P, Sohn J, Inoue K, Pivot X, et al. MONARCH 2: abemaciclib in combination with fulvestrant in women with HR+/HER2− advanced breast cancer who had progressed while receiving endocrine therapy. J Clin Oncol. 2017;35(25):2875–84.

    Article  CAS  PubMed  Google Scholar 

  17. Xie N, Qin T, Ren W, Yao H, Yu Y, Hong H. Efficacy and safety of cyclin-dependent kinases 4 and 6 inhibitors in HR+/HER2− advanced breast cancer. Cancer Manag Res. 2020;12:4241–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dhankhar A, Kumari R, Bahurupi YA. Out-of-pocket, catastrophic health expenditure and distress financing on non-communicable diseases in India: a systematic review with meta-analysis. Asian Pac J Cancer Prev. 2021;22(3):671–80.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An arm and a leg: the rising cost of cancer drugs and impact on access. Am Soc Clin Oncol Educ Book. 2021;41:e1-12.

    Article  Google Scholar 

  20. Health Benefit Package—2.0. Official Website Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, National Health Authority [cited 16 Jun 2021]. Available at: https://pmjay.gov.in/node/1128.

  21. Yang J, Han J, Tian M, Tian K, Liao W, Yan X. Cost-effectiveness of ribociclib for hormone receptor-positive HER2-negative advanced breast cancer. Cancer Manag Res. 2020;12:12905–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mistry R, May JR, Suri G, Young K, Brixner D, Oderda G, et al. 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 US payer perspective. J Manag Care Spec Pharm. 2018;24(6):514–23.

    PubMed  Google Scholar 

  23. Suri G, Chandiwana D, Lee A, Mistry R. Cost-effectiveness analysis of ribociclib plus letrozole versus palbociclib plus letrozole in the United Kingdom. J Health Econ Outcomes Res. 2019;6(2):20–31.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Galve-Calvo E, González-Haba E, Gostkorzewicz J, Martínez I, Pérez-Mitru A. Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2− advanced or metastatic breast cancer in Spain. Clin Outcomes Res. 2018;10:773–90.

    Article  Google Scholar 

  25. Health Technology Assessment in India (HTAIn)—HTAIn manual [cited 21 Nov 2020]. Available at: https://htain.icmr.org.in/index.php/documents/publications/htain-manual.

  26. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16(2):231–50.

    Article  PubMed  Google Scholar 

  27. Slamon DJ, Neven P, Chia S, Fasching PA, De Laurentiis M, Im S-A, et al. Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol. 2018;36(24):2465–72.

    Article  CAS  PubMed  Google Scholar 

  28. Gogia A, Deo SVS, Sharma D, Thulkar S, Kumar R, Malik PS, et al. Clinicopathologic characteristics and treatment outcomes of patients with up-front metastatic breast cancer: single-center experience in India. J Glob Oncol. 2019;5:1–9.

    PubMed  Google Scholar 

  29. Department of Community Medicine and School of Public Health PGIMER Chandigarh [cited 16 Aug 2021]. Available at: https://www.healtheconomics.pgisph.in/costing_web/index.php?action=Cost_data.

  30. Gupta N, Prinja S, Patil V, Bahuguna P. Cost-effectiveness of temozolamide for treatment of glioblastoma multiforme in India. JCO Glob Oncol. 2021;7:108–17.

    Article  PubMed  Google Scholar 

  31. About Pradhan Mantri Jan Arogya Yojana (PM-JAY). Official Website Ayusham Bharat Yojana, National Health Authority [cited 10 Jul 2020]. Available at: https://pmjay.gov.in/about/pmjay.

  32. Giuliano M, Schettini F, Rognoni C, Milani M, Jerusalem G, Bachelot T, et al. Endocrine treatment versus chemotherapy in postmenopausal women with hormone receptor-positive, HER2-negative, metastatic breast cancer: a systematic review and network meta-analysis. Lancet Oncol. 2019;20(10):1360–9.

    Article  CAS  PubMed  Google Scholar 

  33. Prinja S, Dixit J, Gupta N, Mehra N, Singh A, Krishnamurthy MN, et al. Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol. BMJ Open. 2021;11(7):e048513.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Drugs, Surgical and Sutures [cited 5 Jul 2021]. Available at: http://www.rmsc.health.rajasthan.gov.in/content/raj/medical/rajasthan-medical-services-corporation-ltd-/en/Approved-Rate-Lists/DrugsRC.html#.

  35. CGHS rate list—CGHS: Central Government Health Scheme [cited 16 Jun 2021]. Available at: https://cghs.gov.in/index1.php?lang=1&level=3&sublinkid=5948&lid=3881.

  36. US Dollar to Indian Rupee Spot Exchange Rates for 2021 [cited 6 Jul 2021]. Available at: https://www.exchangerates.org.uk/USD-INR-spot-exchange-rates-history-2021.html.

  37. HLL Lifecare—Amrit Medicines [cited 3 Aug 2021]. Available at: http://www.lifecarehll.com/page/render/reference/Amrit_Medicines.

  38. Fox-Rushby J, Cairns J. Economic evaluation. McGraw-Hill Education; 2005 [cited 8 Oct 2020]. Available at: https://mhebooklibrary.com/doi/book/10.1036/9780335225064.

  39. Wilson FR, Varu A, Mitra D, Cameron C, Iyer S. Systematic review and network meta-analysis comparing palbociclib with chemotherapy agents for the treatment of postmenopausal women with HR-positive and HER2-negative advanced/metastatic breast cancer. Breast Cancer Res Treat. 2017;166(1):167–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Registrar General and Census Commissioner of India. SRS BULLETIN 2014 [cited 8 Nov 2020]. Available at: https://censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS%20Bulletin%20-Sepetember%202014.pdf.

  41. Rath S, Elamarthi P, Parab P, Gulia S, Nandhana R, Mokal S, et al. Efficacy and safety of palbociclib and ribociclib in patients with estrogen and/or progesterone receptor positive, HER2 receptor negative metastatic breast cancer in routine clinical practice. PLoS ONE. 2021;16(7):e0253722.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J. Health state utilities for metastatic breast cancer. Br J Cancer. 2006;95(6):683–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Cost-Effectiveness Threshold. YHEC—York Health Economics Consortium [cited 11 Dec 2020]. Available at: https://yhec.co.uk/glossary/cost-effectiveness-threshold/.

  44. GDP per capita (current US$)—India—Data [cited 24 Jun 2020]. Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=IN.

  45. Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: report from National Cancer Registry Programme, India. JCO Glob Oncol. 2020;6:1063–75.

    Article  PubMed  Google Scholar 

  46. Ramani PA, Niharika VS, Lakhsmi BKM, Jahnavi S, Reddy GVS. Incidence of locally advanced breast cancer in women presenting to a tertiary care center. Int Surg J. 2019;6(10):3626–31.

    Article  Google Scholar 

  47. Desai SB, Moonim MT, Gill AK, Punia RS, Naresh KN, Chinoy RF. Hormone receptor status of breast cancer in India: a study of 798 tumours. Breast Edinb Scotl. 2000;9(5):267–70.

    Article  CAS  Google Scholar 

  48. About Pradhan Mantri Jan Arogya Yojana (PM-JAY). Official Website Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, National Health Authority [cited 20 Aug 2021]. Available at: https://pmjay.gov.in/about/pmjay.

  49. Vaikundaraja IM, Dhanushkodi M, Radhakrishnan V, Kalaiarasi JP, Mehra N, Rajan AK, et al. Fulvestrant in hormone-positive advanced breast cancer: real-world outcome. Cancer Res Stat Treat. 2020;3(2):275.

    Article  Google Scholar 

  50. Agrawal C, Doval D, Agarwal A, Goyal P, Baghmar S, Talwar V, et al. Real world evidence of palbociclib use in metastatic hormone positive HER negative metastatic breast cancer in Indian population. Eur J Cancer. 2020;138:S103.

    Article  Google Scholar 

  51. Prinja S, Kaur G, Malhotra P, Jyani G, Ramachandran R, Bahuguna P, et al. Cost-effectiveness of autologous stem cell treatment as compared to conventional chemotherapy for treatment of multiple myeloma in India. Indian J Hematol Blood Transfus. 2017;33(1):31–40.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Aboutorabi A, Hadian M, Ghaderi H, Salehi M, Ghiasipour M. Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer. Glob J Health Sci. 2014;7(1):98–106.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stellato D, Thabane ME, Park J, Chandiwana D, Delea TE. Cost effectiveness of ribociclib in combination with fulvestrant for the treatment of postmenopausal women with HR+/HER2− advanced breast cancer who have received no or only one prior line of endocrine therapy: a Canadian Healthcare perspective. Pharmacoeconomics. 2021;39(9):1045–58.

    Article  PubMed  Google Scholar 

  54. Mamiya H, Tahara RK, Tolaney SM, Choudhry NK, Najafzadeh M. Cost-effectiveness of palbociclib in hormone receptor-positive advanced breast cancer. Ann Oncol. 2017;28(8):1825–31.

    Article  CAS  PubMed  Google Scholar 

  55. Ministry of Statistics and Programme Implementation. Key indicators of social consumption in India: health. NSS 75th round. 2019. Available at: https://www.mospi.gov.in/reports-publications.

  56. Singh MP, Chauhan AS, Rai B, Ghoshal S, Prinja S. Cost of treatment for cervical cancer in India. Asian Pac J Cancer Prev. 2020;21(9):2639–46.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Chauhan AS, Prinja S, Ghoshal S, Verma R, Oinam AS. Cost of treatment for head and neck cancer in India. PLoS ONE. 2018;13(1):e0191132.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  58. Prinja S, Bahuguna P, Duseja A, Kaur M, Chawla YK. Cost of intensive care treatment for liver disorders at tertiary care level in India. PharmacoEconomics Open. 2017;2(2):179–90.

    Article  PubMed Central  Google Scholar 

  59. Dukpa W, Teerawattananon Y, Rattanavipapong W, Srinonprasert V, Tongsri W, Kingkaew P, et al. Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a package of essential non-communicable disease interventions in Bhutan. Health Policy Plan. 2015;30(8):1032–43.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India

    Nidhi Gupta

  2. Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Dharna Gupta, Jyoti Dixit, Gaurav Jyani & Shankar Prinja

  3. Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India

    Nikita Mehra & Jayachandran Perumal Kalaiyarasi

  4. Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India

    Ashish Singh

  5. Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India

    Manjunath Nookala Krishnamurthy

  6. Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India

    Kavitha Rajsekhar

  7. Department of Medical Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India

    Partha Sarathi Roy

  8. Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Prabhat Singh Malik, Anisha Mathew & Lalit Kumar

  9. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Pankaj Malhotra

  10. Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India

    Sudeep Gupta

  11. Department of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India

    Amal Kataki

  12. Homi Bhabha National Institute, Mumbai, Maharashtra, India

    Manjunath Nookala Krishnamurthy & Sudeep Gupta

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  1. Nidhi Gupta
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Corresponding author

Correspondence to Shankar Prinja.

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Funding

This work was supported by the Department of Health Research, Ministry of Health and Family Welfare, Government of India, vide Grant number F.No.T.11011/02/2017-HR/3100291.

Conflict of interest

Sudeep Gupta has participated in research projects sponsored by Pfizer, Novartis, and Eli Lilly for which research funding was provided by these companies to his institution. Nidhi Gupta, Dharna Gupta, Jyoti Dixit, Nikita Mehra, Ashish Singh, Manjunath Nookala Krishnamurthy, Gaurav Jyani, Kavitha Rajsekhar, Jayachandran Perumal Kalaiyarasi, Partha Sarathi Roy, Prabhat Singh Malik, Anisha Mathew, Pankaj Malhotra, Lalit Kumar, Amal Kataki, and Shankar Prinja declare no conflicts of interest.

Availability of data and material (data transparency)

The datasets generated and/or analyzed during the current study are available from the corresponding author on request.

Code availability (software application or custom code)

The code that supports the findings of this study is available from the corresponding author on request.

Ethical approval

The study protocol was approved by the Institutional Ethics Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India (IEC-03/2020-1565).

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Written informed consent was obtained from all study participants.

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Not applicable.

Author contributions

Study conception: SP, NG, DG and JD. Study design: NG, DG, SP and JD. Analysis: DG, JD, NG and SP. Writing (first draft): DG, NG and SP. Writing (review and editing): All authors.

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Gupta, N., Gupta, D., Dixit, J. et al. Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women. Appl Health Econ Health Policy 20, 609–621 (2022). https://doi.org/10.1007/s40258-022-00731-2

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