OBJECTIVES:

Estimate the cost-effectiveness of Ribociclib + ET compared to Letrozole, Palbociclib + ET, Fulvestrant, Anastrozole, Capacitabine and Tamoxifen, as the first line treatment for post menopausal patients with HR+, HER2- advanced breast cancer.

METHODS:

We used a partitioned survival model with three health and two substates were considered for the progression free state. The clinical input for this model was the Monaleesa-2 study. The time horizon for this analysis was 30 years and costs were estimated USD. The discount rate, for both costs and QALYs, was 3%. The sources of information used to estimate costs was the National Tariff Schedule for the Ecuadorian Health System, as well as information from SERCOP and the Technical Secretariat for Drug Pricing.

RESULTS:

In the base scenario, Ribociclib-Letrozole combination provides 4.112 QALY gain compared to 2.932 QALY which is the option with the least QALY gain. The ICER for Ribociclib-Letrozole is $38,030 per additional QALY, as compared to Letrozole alone. Despite the outstanding health benefits, the value per QALY for the Ribociclib-Letrozole is greater than the 1 or 3 GDP per capita threshold.

CONCLUSIONS:

The results of the study indicate that the combined treatment strategy with Ribociclib and Letrozole is the most effective strategy among Letrozole, Palbociclib + ET (or LET), Fulvestrant, Anastrozole, Capacitabine and Tamoxifen. This drug combination was able to demonstrate the highest gain in QALYs compared to Letrozole. Ribociclib-Letrozole is the option most likely to be cost-effective if the willingness to pay threshold reaches $USD 40,000.00.

The demonstration of the large gains in QALYs attributable to Ribociclib-Letrozole compared to the other therapies, is a relevant result that is not common in cancer therapy evaluations. Ribociclib has the potential to position itself as an attractive therapy to be incorporated into the National List of Essential Medicines.