Presentation (CTI)

OBJECTIVES: Ribociclib and endocrine therapy has been showing promising clinical results for treating HR+, HER2- early breast cancer patients. This cost-effectiveness evaluation uses a recent clinical trial (NATALEE) data to evaluate the cost-effectiveness of using ribociclib and endocrine therapy as a first line treatment in premenopausal women with HR+, HER2- Early Breast Cancer in the UK.
METHODS: A Markov model with five stages was developed from the UK health systems perspective over a lifetime horizon (49 years). Clinical parameters are obtained from the NATALEE trial and survival curves are extrapolated beyond trial period. Costs are derived from previous NICE technology appraisals with similar patient group and UK based data sources, utilities are sourced from literature or previous appraisals with similar patient groups. One way sensitivity analysis and probabilistic analyses are conducted. Cost are inflated using the NHS cost inflation index, and a discount rate of 3.5% was applied to both costs and outcomes as per NICE reference case.
RESULTS: This study finds an incremental cost-effectiveness ratio (ICER) of 106,420 pounds per quality adjusted life year, which is above the National Institute for Health and Care Excellence (NICE) threshold of 30,000. Sensitivity analyses shows that ICER is most responsive to ribociclib drug discounts, but results remain robust against all other parameter testing which include uncertainties in costs, utilities, and probabilities.
CONCLUSIONS: At its current list price, ribociclib and endocrine therapy is unlikely to be a cost-effective intervention compared to endocrine therapy in the UK.