COST-UTILITY ANALYSIS OF RIBOCICLIB PLUS LETROZOLE VERSUS LETROZOLE MONOTHERAPY IN PREMENOPAUSAL AND PERIMENOPAUSAL WOMEN WITH HR+/HER2 ADVANCED BREAST CANCER: A MARKOV MODEL-BASED EVALUATION FROM AN INDIAN HEALTHCARE PERSPECTIVE
Author(s)
Norah E. Shynu, PharmD1, Shruthi Ashok Kumar, PharmD2, Arathi Viswam, PharmD3, Anna Ankita, PharmD3, Adusumilli Pramod Kumar, phD3.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
OBJECTIVES: To evaluate the cost-utility of ribociclib plus letrozole compared with letrozole monotherapy in premenopausal and perimenopausal women with HR+/HER2 advanced breast cancer from an Indian healthcare perspective
METHODS: A state-transition Markov model comprising progression-free survival, progressed disease, and death health states was developed using clinical efficacy inputs derived from the phase III MONALEESA-7 trial. The model employed a 1-month cycle length, a 10-year time horizon (120 cycles), and a 3% annual discount rate for both costs and health outcomes. Direct medical costs and health-state utility values were incorporated to estimate total costs and quality-adjusted life years (QALYs). Outcomes included total costs, incremental costs, incremental QALYs, and incremental cost-effectiveness ratios (ICERs). Uncertainty was assessed through probabilistic sensitivity analysis (PSA) using 10,000 Monte Carlo simulations. Results were evaluated against willingness-to-pay thresholds in India.
RESULTS: : Ribociclib plus letrozole generated 3.1384 QALYs at a total cost of ₹7,131,950.99 (€66,327.14), whereas letrozole monotherapy generated 1.2036 QALYs at a total cost of ₹554,663.02 (€5,158.37). The combination therapy yielded an incremental gain of 1.9347 QALYs and an additional cost of ₹6,577,287.97 (€61,168.78). The resulting ICER was ₹3,399,799 per QALY gained (€31,618.13 per QALY gained). Sensitivity analyses identified drug acquisition costs and survival parameters as the primary drivers of cost-effectiveness. PSA demonstrated that ribociclib plus letrozole consistently improved health outcomes; however, the ICER exceeded commonly accepted willingness-to-pay thresholds in India, indicating a low probability of cost-effectiveness under current pricing conditions.
CONCLUSIONS: Ribociclib plus letrozole provides substantial improvements in quality-adjusted survival compared with letrozole monotherapy in premenopausal and perimenopausal women with HR+/HER2 advanced breast cancer. Despite these clinical benefits, the considerable increase in treatment costs results in an ICER that exceeds commonly accepted Indian willingness-to-pay thresholds
METHODS: A state-transition Markov model comprising progression-free survival, progressed disease, and death health states was developed using clinical efficacy inputs derived from the phase III MONALEESA-7 trial. The model employed a 1-month cycle length, a 10-year time horizon (120 cycles), and a 3% annual discount rate for both costs and health outcomes. Direct medical costs and health-state utility values were incorporated to estimate total costs and quality-adjusted life years (QALYs). Outcomes included total costs, incremental costs, incremental QALYs, and incremental cost-effectiveness ratios (ICERs). Uncertainty was assessed through probabilistic sensitivity analysis (PSA) using 10,000 Monte Carlo simulations. Results were evaluated against willingness-to-pay thresholds in India.
RESULTS: : Ribociclib plus letrozole generated 3.1384 QALYs at a total cost of ₹7,131,950.99 (€66,327.14), whereas letrozole monotherapy generated 1.2036 QALYs at a total cost of ₹554,663.02 (€5,158.37). The combination therapy yielded an incremental gain of 1.9347 QALYs and an additional cost of ₹6,577,287.97 (€61,168.78). The resulting ICER was ₹3,399,799 per QALY gained (€31,618.13 per QALY gained). Sensitivity analyses identified drug acquisition costs and survival parameters as the primary drivers of cost-effectiveness. PSA demonstrated that ribociclib plus letrozole consistently improved health outcomes; however, the ICER exceeded commonly accepted willingness-to-pay thresholds in India, indicating a low probability of cost-effectiveness under current pricing conditions.
CONCLUSIONS: Ribociclib plus letrozole provides substantial improvements in quality-adjusted survival compared with letrozole monotherapy in premenopausal and perimenopausal women with HR+/HER2 advanced breast cancer. Despite these clinical benefits, the considerable increase in treatment costs results in an ICER that exceeds commonly accepted Indian willingness-to-pay thresholds
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO166
Topic
Clinical Outcomes, Economic Evaluation, Methodological & Statistical Research
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Personalized & Precision Medicine