BIREOCICLIB PLUS FULVESTRANT FOR HR+/HER2- ADVANCED OR METASTATIC BREAST CANCER: A COST-EFFECTIVENESS ANALYSIS
Author(s)
Yuanbao Xie, Bachelor1, Yu Chen, Master1, Jingjing Wu, Master1, Xinyue Yuan, Bachelor1, xianghui Duan, Master2, Fei Liu, PhD2, MING HU, PhD1;
1West China School of Pharmacy,Sichuan University, Chengdu, China, 2Xuanzhu Biopharmaceutical Co.Ltd., Beijing, China
1West China School of Pharmacy,Sichuan University, Chengdu, China, 2Xuanzhu Biopharmaceutical Co.Ltd., Beijing, China
OBJECTIVES: To evaluate the cost-effectiveness of bireociclib plus fulvestrant for patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer who have progressed after endocrine therapy
METHODS: A partitioned survival model was developed to simulate the disease progression over a 15-year time horizon from the Chinese healthcare system perspective. Abemaciclib plus fulvestrant was selected as the comparator, with matching-adjusted indirect comparison (MAIC) employed to adjust for cross-trial population heterogeneity. Efficacy and safety inputs were derived from BRIGHT-2 and MONARCH-2 trials. Costs, utilities, and background mortality rates were sourced from published literatures and databases. Both costs and outcomes were discounted at an annual rate of 5%. We built two survival extrapolation scenarios: scenario 1 involved fitting optimal parametric distributions separately for the bireociclib and abemaciclib arms; Scenario 2 extrapolated the long-term survival of bireociclib by applying the MAIC-adjusted hazard ratio to the best-fitted model of the abemaciclib arm. Using incremental cost-effectiveness ratio (ICER) as the primary metric and a willingness‑to‑pay (WTP) threshold of CNY 95,749 (2024 per‑capita GDP of China), we conducted sensitivity analyses to explore model uncertainty.
RESULTS: In scenario 1, bireociclib plus fulvestrant cost CNY 343,824 for 3.07 quality-adjueted life years (QALYs) gained, whereas abemaciclib plus fulvestrant cost 343,699 for 2.48 QALYs, resulting in an ICER of CNY 214/QALY. Probabilistic sensitivity analysis estimated a 71.0% probability of cost-effectiveness at a threshold of CNY 95,749/QALY. In scenario 2, bireociclib plus fulvestrant (CNY 304,383 for 2.96 QALYs) demonstrated dominance over abemaciclib plus fulvestrant (CNY 343,699 for 2.48 QALYs). Probabilistic sensitivity analysis estimated an 84.8% probability of cost-effectiveness at the WTP threshold.
CONCLUSIONS: Current evidence suggests that bireociclib combined with fulvestrant is a cost-effective alternative to abemaciclib plus fulvestrant. However, given the limited 8-month follow-up of BRIGHT-2 trial, these findings warrant further validation as mature long-term survival data becomes available
METHODS: A partitioned survival model was developed to simulate the disease progression over a 15-year time horizon from the Chinese healthcare system perspective. Abemaciclib plus fulvestrant was selected as the comparator, with matching-adjusted indirect comparison (MAIC) employed to adjust for cross-trial population heterogeneity. Efficacy and safety inputs were derived from BRIGHT-2 and MONARCH-2 trials. Costs, utilities, and background mortality rates were sourced from published literatures and databases. Both costs and outcomes were discounted at an annual rate of 5%. We built two survival extrapolation scenarios: scenario 1 involved fitting optimal parametric distributions separately for the bireociclib and abemaciclib arms; Scenario 2 extrapolated the long-term survival of bireociclib by applying the MAIC-adjusted hazard ratio to the best-fitted model of the abemaciclib arm. Using incremental cost-effectiveness ratio (ICER) as the primary metric and a willingness‑to‑pay (WTP) threshold of CNY 95,749 (2024 per‑capita GDP of China), we conducted sensitivity analyses to explore model uncertainty.
RESULTS: In scenario 1, bireociclib plus fulvestrant cost CNY 343,824 for 3.07 quality-adjueted life years (QALYs) gained, whereas abemaciclib plus fulvestrant cost 343,699 for 2.48 QALYs, resulting in an ICER of CNY 214/QALY. Probabilistic sensitivity analysis estimated a 71.0% probability of cost-effectiveness at a threshold of CNY 95,749/QALY. In scenario 2, bireociclib plus fulvestrant (CNY 304,383 for 2.96 QALYs) demonstrated dominance over abemaciclib plus fulvestrant (CNY 343,699 for 2.48 QALYs). Probabilistic sensitivity analysis estimated an 84.8% probability of cost-effectiveness at the WTP threshold.
CONCLUSIONS: Current evidence suggests that bireociclib combined with fulvestrant is a cost-effective alternative to abemaciclib plus fulvestrant. However, given the limited 8-month follow-up of BRIGHT-2 trial, these findings warrant further validation as mature long-term survival data becomes available
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE474
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology