Abstract
Purpose
Three CDK4/6 inhibitors, palbociclib (PAL), ribociclib (RIB), and abemaciclib, when combined with letrozole (LET), have been approved as first-line therapy for postmenopausal women with metastatic HR+, HER2− breast cancer. However, an economic evaluation of these newer therapies is currently lacking. The purpose of this article is to evaluate the cost-effectiveness of PAL or RIB for the treatment of advanced HR+, HER2− breast cancer in the United States.
Methods
A Markov simulation model was constructed using data from published clinical trials evaluating PAL and RIB. Three simulated treatment strategies included PAL + LET, RIB + LET, or LET alone. The main outcome measures were simulated progression-free survival (PFS), overall survival (OS), costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
Results
Simulated median OS was 38.9 months for PAL + LET and 33.0 months for LET alone. Simulated median OS for RIB + LET was 43.3 months. Compared to LET alone, PAL + LET provided an additional 0.48 QALYs, on average, with an ICER of $634,000 per QALY gained; RIB + LET provided an additional 0.86 QALYs, on average, with an ICER of $440,000 per QALY gained. At current prices, neither PAL nor RIB was cost-effective, assuming a willingness-to-pay threshold of $100,000 per QALY gained. To reach such a cost-effectiveness threshold, PAL and RIB prices must decrease by approximately 70%.
Conclusion
Despite significant gains in progression-free survival over letrozole alone, the addition of palbociclib or ribociclib in the treatment of advanced HR+, HER2− breast cancer is not cost-effective in the United States given current drug prices.
References
Finn RS, Crown JP, Lang I et al (2015) The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Oncol 16(1):25–35
Finn RS, Crown J, Lang I et al (2017) Overall survival results from the randomized phase II study of palbociclib (P) in combination with letrozole (L) vs letrozole alone for frontline treatment of ER+/HER2– advanced breast cancer (PALOMA-1; TRIO-18). J Clin Oncol 35(15_suppl):1001–1001
Hortobagyi GN, Stemmer SM, Burris HA et al (2016) Ribociclib as first-line therapy for HR-positive, advanced breast cancer. N Engl J Med 375(18):1738–1748
Hortobagyi GN, Stemmer SM, Burris HA et al (2018) Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol 29:1541–1547
Delea TE, Hawkes C, Amonkar MM, Lykopoulos K, Johnston SR (2013) Cost-effectiveness of lapatinib plus letrozole in post-menopausal women with hormone receptor-and HER2-positive metastatic breast cancer. Breast Care (Basel) 8(6):429–437
Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J (2006) Health state utilities for metastatic breast cancer. Br J Cancer 95(6):683–690
Sorensen SV, Goh JW, Pan F et al (2012) Incidence-based cost-of-illness model for metastatic breast cancer in the United States. Int J Technol Assess Health Care 28(1):12–21
Stokes ME, Muehlenbein CE, Marciniak MD et al (2009) Neutropenia-related costs in patients treated with first-line chemotherapy for advanced non-small cell lung cancer. J Manag Care Pharm 15(8):669–682
Tengs TO, Wallace A (2000) One thousand health-related quality-of-life estimates. Med Care 38(6):583–637
Xie J, Hao Y, Zhou ZY, Qi CZ, De G, Gluck S (2015) Economic evaluations of everolimus versus other hormonal therapies in the treatment of HR+/HER2− advanced breast cancer from a US payer perspective. Clin Breast Cancer 15(5):e263–e276
Mamiya H, Tahara RK, Tolaney SM, Choudhry NK, Najafzadeh M (2017) Cost-effectiveness of palbociclib in hormone receptor-positive advanced breast cancer. Ann Oncol 28(8):1825–1831
Matter-Walstra K, Ruhstaller T, Klingbiel D, Schwenkglenks M, Dedes KJ (2016) Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK). Breast Cancer Res Treat 158(1):51–57
Mistry R, May JR, Suri G et al (2018) 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. J Manag Care Spec Pharm 24(6):514–523
Patnaik A, Rosen LS, Tolaney SM et al (2016) Efficacy and safety of abemaciclib, an inhibitor of CDK4 and CDK6, for patients with breast cancer, non-small cell lung cancer, and other solid tumors. Cancer Discov 6(7):740–753
Mariotto AB, Etzioni R, Hurlbert M, Penberthy L, Mayer M (2017) Estimation of the number of women living with metastatic breast cancer in the United States. Cancer Epidemiol Biomark Prev 26(6):809–815
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This study was not supported by any pharmaceutical company.
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Zhang, B., Long, E.F. Cost-effectiveness analysis of palbociclib or ribociclib in the treatment of advanced hormone receptor-positive, HER2-negative breast cancer. Breast Cancer Res Treat 175, 775–779 (2019). https://doi.org/10.1007/s10549-019-05190-3
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DOI: https://doi.org/10.1007/s10549-019-05190-3