OBJECTIVES

To estimate cost and budget impact of establishing ribociclib+letrozole (ribociclib) as a first-line treatment option for post-menopausal women with HR+/HER2- advanced or metastatic breast cancer compared to palbociclib+letrozole (palbociclib) in Denmark.

METHODS

A two-year budget impact model with a Danish national payer perspective was developed to calculate the incremental cost of introducing ribociclib in patients with HR+/HER2- breast cancer eligible for treatment. Progression-free survival, incidence and type of adverse events and dose distributions were all from the registration trial MONALEESA-2. Acquisition costs (pharmacy purchasing price), monitoring, health state cost (progression-free and post-progression) and cost associated with relevant grade 3 and 4 adverse events, were included based on Danish tariffs. 270 patients were assumed eligible for treatment every year, based on clinical experts. New patients would enter the model each year and patients could exit due to death. The budget impact was calculated based on two treatment mixes, one where ribociclib is not considered as standard treatment and one where ribociclib is considered standard treatment.

RESULTS

In a cohort of 270 patients per year, the inclusion of ribociclib would be associated with a total saving of approximately DKK 4.3 million for a time horizon of two years. Ribociclib has a lower acquisition cost for the lower doses of 400 and 200 mg, while palbociclib has a flat acquisition cost for all three doses. Hence, the cost-savings related to ribociclib are mostly due to reduced drug costs due to down dosing. Increased costs were observed for adverse events and monitoring; however, based on clinical feedback, the payer’s appraisal assumed no difference in these.

CONCLUSIONS

The budget impact of introducing ribociclib as standard treatment in Denmark is cost-saving compared to palbociclib for the first line treatment of postmenopausal women with HR-positive, HER2-negative advanced breast cancer.