COST-EFFECTIVENESS ANALYSIS OF RIBOCICLIB PLUS ENDOCRINE THERAPY (ET) VERSUS ABEMACICLIB PLUS ET IN THE ADJUVANT TREATMENT OF NODE POSITIVE PRE AND POSTMENOPAUSAL WOMEN WITH HR+/HER2- EARLY BREAST CANCER (EBC): A CANADIAN PAYER PERSPECTIVE
Author(s)
Dina Soliman, BA, MSc1, Sandeep Sehdev, MD, FRCPC2, Christine Brezden-Masley, MD, PhD, FRCPC3, Natalia Sabater Anaya, M.S. Economics4, Talitha Vincken, M.S.5, Daniel Stellato, M.S. Economics4, Khalid El Ouagari, PhD6.
1HEOR Director, Novartis, Montreal, QC, Canada, 2Ottawa Hospital, Ottawa, ON, Canada, 3Mount Sinai Hospital, Toronto, ON, Canada, 4Avalere Health, Boston, MA, USA, 5Avalere Health, London, United Kingdom, 6Novartis Pharmaceuticals Canada, Montreal, QC, Canada.
1HEOR Director, Novartis, Montreal, QC, Canada, 2Ottawa Hospital, Ottawa, ON, Canada, 3Mount Sinai Hospital, Toronto, ON, Canada, 4Avalere Health, Boston, MA, USA, 5Avalere Health, London, United Kingdom, 6Novartis Pharmaceuticals Canada, Montreal, QC, Canada.
OBJECTIVES: To evaluate the cost-effectiveness of ribociclib vs abemaciclib in the adjuvant treatment of Stage II and III node positive pre and postmenopausal women with HR+/HER2− EBC
METHODS: A Markov model was developed considering 6 health states: invasive disease-free survival (iDFS), second primary malignancy (SPM), non-metastatic recurrence (NMR), remission, distant recurrence (DR), and death. Transition probabilities between health states were estimated using time-to-event analysis of iDFS and distribution of events (SPM, NMR, DR and death). Data was obtained from the monarchE-eligible subgroup (i.e., subjects in NATALEE who would meet eligibility criteria for monarchE) of the latest 4 year data cut-off of NATALEE trial, results from an indirect treatment comparison (ITC) of ribociclib plus ET versus abemaciclib plus ET, and published sources. Analyses were conducted over a lifetime horizon from a Canadian healthcare system perspective. Cost included are related to drug acquisition, healthcare resources, subsequent therapies, and adverse event management costs. Trial data and published literature were used to derive utility values. Costs and effects were discounted at 1.5%.
RESULTS: Based on probabilistic analyses and over a lifetime horizon, ribociclib plus ET resulted in QALY gain of 0.01 and cost savings of CAD 16,672 when compared to abemaciclib plus ET. Total treatment costs per patient with ribociclib plus ET and abemaciclib plus ET were CAD155,277 and CAD 171,949 respectively. Ribociclib plus ET is a dominant treatment option over abemaciclib plus ET as it yielded a QALY gain with lower total costs.
CONCLUSIONS: Ribociclib offers a new effective and safe treatment option to further reduce this risk of recurrence for a broad population of HR+/HER2− EBC patients. Additionally, ribociclib plus ET is a dominant option when compared to two years of abemaciclib plus ET for the adjuvant treatment of node positive women with HR+/HER2− EBC
METHODS: A Markov model was developed considering 6 health states: invasive disease-free survival (iDFS), second primary malignancy (SPM), non-metastatic recurrence (NMR), remission, distant recurrence (DR), and death. Transition probabilities between health states were estimated using time-to-event analysis of iDFS and distribution of events (SPM, NMR, DR and death). Data was obtained from the monarchE-eligible subgroup (i.e., subjects in NATALEE who would meet eligibility criteria for monarchE) of the latest 4 year data cut-off of NATALEE trial, results from an indirect treatment comparison (ITC) of ribociclib plus ET versus abemaciclib plus ET, and published sources. Analyses were conducted over a lifetime horizon from a Canadian healthcare system perspective. Cost included are related to drug acquisition, healthcare resources, subsequent therapies, and adverse event management costs. Trial data and published literature were used to derive utility values. Costs and effects were discounted at 1.5%.
RESULTS: Based on probabilistic analyses and over a lifetime horizon, ribociclib plus ET resulted in QALY gain of 0.01 and cost savings of CAD 16,672 when compared to abemaciclib plus ET. Total treatment costs per patient with ribociclib plus ET and abemaciclib plus ET were CAD155,277 and CAD 171,949 respectively. Ribociclib plus ET is a dominant treatment option over abemaciclib plus ET as it yielded a QALY gain with lower total costs.
CONCLUSIONS: Ribociclib offers a new effective and safe treatment option to further reduce this risk of recurrence for a broad population of HR+/HER2− EBC patients. Additionally, ribociclib plus ET is a dominant option when compared to two years of abemaciclib plus ET for the adjuvant treatment of node positive women with HR+/HER2− EBC
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE43
Topic
Economic Evaluation
Disease
SDC: Oncology