Cost-Effectiveness Analysis of Ribociclib Plus Endocrine Therapy for the Treatment of HR/HER2 Early Breast Cancer in Greece

Author(s)

Marios Athanasios Loupas, MSc1, Vasiliki Antonopoulou, MSc2, Maria Kalogeropoulou, PhD1.
1IQVIA HELLAS S.A., Athens, Greece, 2NOVARTIS, Athens, Greece.
OBJECTIVES: To assess the cost-effectiveness of ribociclib +endocrine therapy (ET) versus ET monotherapy as adjuvant therapy for patients with HR+/HER2- early breast cancer (eBC) from the Greek healthcare system perspective, according to the inclusion criteria and intervention in NATALEE trial. Additionally, a subgroup analysis comparing ribociclib+ET and abemaciclib+ET was performed in MonarchE-eligible patients.
METHODS: A semi-Markov cohort model with 28-day cycles was locally adapted to simulate the clinical and economic outcomes. Six health states were included: invasive disease-free survival (IDFS), second primary malignancy (SPM), non-metastatic recurrence (NMR), remission, distant recurrence (DR), and death. Patients entered in the IDFS and transitioned based on time-dependent probabilities. IDFS was modeled using parametric survival models fitted to patient-level data from the NATALEE trial (data cutoff April 29, 2024). For abemaciclib+ET, IDFS was modeled by applying a hazard ratio from a matching-adjusted indirect comparison to the ribociclib+ET curve. In the DR state, patients received subsequent treatment with fixed LYs and QALYs based on MONALEESA-2/3 outcomes. Deterministic and probabilistic sensitivity analyses were conducted. Direct costs (€, 2025) were considered and derived from official Greek sources.
RESULTS: The deterministic ICER for ribociclib+ET versus ET monotherapy was €19,502 per QALY gained, while the probabilistic ICER was €7,928, indicating a cost-effective treatment option. Ribociclib+ET and ET alone incurred the highest costs during the IDFS and DR phases, respectively. This reflects the longer event-free duration in the ribociclib arm and the greater need for subsequent treatment following relapse in the ET arm. In the MonarchE-eligible subgroup, ribociclib + ET dominated abemaciclib+ET, offering comparable health outcomes at a lower overall cost.
CONCLUSIONS: Ribociclib+ET as a treatment choice for patients with HR+/HER2- eBC in Greece is likely to lead to substantial gains in life expectancy and QALYs compared to ET monotherapy, and result in cost savings and QALY gains compared to abemaciclib+ET.

Conference/Value in Health Info

2025-11, ISPOR Europe 2025, Glasgow, Scotland

Value in Health, Volume 28, Issue S2

Code

PT35

Topic

Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment

Disease

Oncology

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