COST-EFFECTIVENESS ANALYSIS OF BIREOCICLIB VERSUS ABEMACICLIB IN HR+/HER2- ADVANCED OR METASTATIC BREAST CANCER: COMPARING MATCHING-ADJUSTED INDIRECT COMPARISON AND SIMULATED TREATMENT COMPARISON APPROACHES
Author(s)
Yu Chen, Master1, Yuanbao Xie, Bachelor1, Xinyue Yuan, Bachelor1, Jingjing Wu, Master1, Fei Liu, PhD2, xianghui Duan, Master2, MING HU, PhD3;
1Sichuan University, Chengdu, China, 2Xuanzhu Biopharmaceutical Co.Ltd., Beijing, China, 3Sichuan University, Professor, Chengdu, China
1Sichuan University, Chengdu, China, 2Xuanzhu Biopharmaceutical Co.Ltd., Beijing, China, 3Sichuan University, Professor, Chengdu, China
OBJECTIVES: To evaluate the cost-effectiveness of bireociclib versus abemaciclib in patients with HR+/HER2- advanced or metastatic breast cancer who have progressed after endocrine therapies. And to compare outcomes generated by two cross-trial adjustment approaches: Matching-Adjusted Indirect Comparison (MAIC) and Simulated Treatment Comparison (STC).
METHODS: A partitioned survival model was developed from the Chinese healthcare system perspective with a 15-year time horizon. Efficacy and safety inputs were derived from two single-arm phase II trials (MONARCH-1and BRIGHT-1). Costs, utilities, and mortality data were obtained from literature and national databases, with the price of abemaciclib derived from the latest PharmCube data and that of bireociclib from the 2025 national drug price negotiation. Both costs and outcomes were discounted at a rate of 5% annually. The primary outcome was the incremental cost‑effectiveness ratio (ICER), compared against a willingness‑to‑pay (WTP) threshold of China’s 2024 per‑capita GDP (¥95,749). Two adjustment scenarios(MAIC and STC) were implemented. Deterministic and probabilistic sensitivity analyses were performed to test model robustness.
RESULTS: In scenario using MAIC‑adjusted survival data, bireociclib was the dominant strategy over abemaciclib, providing an additional 0.452 quality‑adjusted life‑years (QALYs) while saving costs. When applying STC‑adjusted data, bireociclib remained cost‑effective with an ICER of ¥13,600 per QALY. Survival curves for Bireociclib differed between the two methods, with STC predicting longer mean survival times compared to MAIC. Probabilistic sensitivity analysis showed that at the WTP threshold, the probability of bireociclib being cost‑effective was 73.9% under the MAIC scenario and 77.4% under the STC scenario.
CONCLUSIONS: Bireociclib was consistently estimated as a cost‑effective option compared with abemaciclib in this population. STC showed more positive survival outcomes than MAIC. However, considering the inherent methodological uncertainty in both MAIC and STC, the findings should be interpreted with consideration of these uncertainties, and further validation through head‑to‑head trials or real‑world studies is warranted.
METHODS: A partitioned survival model was developed from the Chinese healthcare system perspective with a 15-year time horizon. Efficacy and safety inputs were derived from two single-arm phase II trials (MONARCH-1and BRIGHT-1). Costs, utilities, and mortality data were obtained from literature and national databases, with the price of abemaciclib derived from the latest PharmCube data and that of bireociclib from the 2025 national drug price negotiation. Both costs and outcomes were discounted at a rate of 5% annually. The primary outcome was the incremental cost‑effectiveness ratio (ICER), compared against a willingness‑to‑pay (WTP) threshold of China’s 2024 per‑capita GDP (¥95,749). Two adjustment scenarios(MAIC and STC) were implemented. Deterministic and probabilistic sensitivity analyses were performed to test model robustness.
RESULTS: In scenario using MAIC‑adjusted survival data, bireociclib was the dominant strategy over abemaciclib, providing an additional 0.452 quality‑adjusted life‑years (QALYs) while saving costs. When applying STC‑adjusted data, bireociclib remained cost‑effective with an ICER of ¥13,600 per QALY. Survival curves for Bireociclib differed between the two methods, with STC predicting longer mean survival times compared to MAIC. Probabilistic sensitivity analysis showed that at the WTP threshold, the probability of bireociclib being cost‑effective was 73.9% under the MAIC scenario and 77.4% under the STC scenario.
CONCLUSIONS: Bireociclib was consistently estimated as a cost‑effective option compared with abemaciclib in this population. STC showed more positive survival outcomes than MAIC. However, considering the inherent methodological uncertainty in both MAIC and STC, the findings should be interpreted with consideration of these uncertainties, and further validation through head‑to‑head trials or real‑world studies is warranted.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE369
Topic
Economic Evaluation
Disease
SDC: Oncology