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.
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.
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