COST-EFFECTIVENESS OF CDK4/6 INHIBITORS FOR HR+/HER2- METASTATIC BREAST CANCER IN KAZAKHSTAN
Author(s)
Shynggys Sergazy, PhD1, Abrakhmanov Ramil, PhD, MD2, Alexander Kostyuk, PhD, MD3, Alima Almadiyeva, MSc, MSPH, MD4, Talgat S. Nurgozhin, Sr., PhD, MD3;
1VictusPharm, Astana, Kazakhstan, 2Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan, 3Kazakhstan Association of health technologies assessment, evidence based medicine and pharmacoecon, Astana, Kazakhstan, 4KazSPOR, Astana, Kazakhstan
1VictusPharm, Astana, Kazakhstan, 2Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan, 3Kazakhstan Association of health technologies assessment, evidence based medicine and pharmacoecon, Astana, Kazakhstan, 4KazSPOR, Astana, Kazakhstan
OBJECTIVES: Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with endocrine therapy represent the standard of care for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer (mBC). However, their high cost poses challenges for reimbursement decisions in resource-limited settings. This study aimed to evaluate the cost-effectiveness of CDK4/6 inhibitors, with a focus on ribociclib compared with palbociclib and abemaciclib, from the perspective of the healthcare system of the Republic of Kazakhstan.
METHODS: A pharmacoeconomic evaluation was conducted using a cost-utility analysis framework. Clinical effectiveness data were derived from pivotal randomized controlled trials, including the MONALEESA, PALOMA, and MONARCH study programs. Health outcomes were expressed in quality-adjusted life years (QALYs). Direct medical costs included drug acquisition costs based on nationally regulated ceiling prices, calculated per 28-day treatment cycle. The incremental cost-effectiveness ratio (ICER) was estimated for ribociclib versus palbociclib and abemaciclib. A willingness-to-pay threshold of 1-3 times gross domestic product (GDP) per capita per QALY was applied. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.
RESULTS: Ribociclib demonstrated comparable or superior overall survival benefits relative to alternative CDK4/6 inhibitors, with lower total treatment costs. The ICER for palbociclib versus ribociclib exceeded ₸43 million per QALY, while the ICER for abemaciclib versus ribociclib exceeded ₸35 million per QALY, both surpassing the accepted willingness-to-pay threshold for Kazakhstan. Sensitivity analyses confirmed the robustness of the results, identifying drug acquisition costs and survival outcomes as key drivers. Budget impact estimates suggested substantial potential cost savings when ribociclib is prioritized for treatment.
CONCLUSIONS: From the healthcare system perspective of Kazakhstan, ribociclib represents the most cost-effective CDK4/6 inhibitor for the treatment of HR+/HER2− metastatic breast cancer. Prioritizing ribociclib in reimbursement and procurement decisions may improve clinical outcomes while ensuring more efficient use of limited healthcare resources.
METHODS: A pharmacoeconomic evaluation was conducted using a cost-utility analysis framework. Clinical effectiveness data were derived from pivotal randomized controlled trials, including the MONALEESA, PALOMA, and MONARCH study programs. Health outcomes were expressed in quality-adjusted life years (QALYs). Direct medical costs included drug acquisition costs based on nationally regulated ceiling prices, calculated per 28-day treatment cycle. The incremental cost-effectiveness ratio (ICER) was estimated for ribociclib versus palbociclib and abemaciclib. A willingness-to-pay threshold of 1-3 times gross domestic product (GDP) per capita per QALY was applied. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.
RESULTS: Ribociclib demonstrated comparable or superior overall survival benefits relative to alternative CDK4/6 inhibitors, with lower total treatment costs. The ICER for palbociclib versus ribociclib exceeded ₸43 million per QALY, while the ICER for abemaciclib versus ribociclib exceeded ₸35 million per QALY, both surpassing the accepted willingness-to-pay threshold for Kazakhstan. Sensitivity analyses confirmed the robustness of the results, identifying drug acquisition costs and survival outcomes as key drivers. Budget impact estimates suggested substantial potential cost savings when ribociclib is prioritized for treatment.
CONCLUSIONS: From the healthcare system perspective of Kazakhstan, ribociclib represents the most cost-effective CDK4/6 inhibitor for the treatment of HR+/HER2− metastatic breast cancer. Prioritizing ribociclib in reimbursement and procurement decisions may improve clinical outcomes while ensuring more efficient use of limited healthcare resources.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE59
Topic
Economic Evaluation
Disease
SDC: Oncology