OBJECTIVES: The objective of the study is to evaluate the cost effectiveness (CE) of ribociclib plus a non-steroidal aromatase inhibitor (NSAI) and goserelin (ribociclib treatment hereafter) for pre- and peri-menopausal women with HR+/HER2- advanced breast cancer (ABC) who have not received prior hormonal therapy.

METHODS: A Markov model with a 15-year time horizon and a 28-day cycle length was designed to evaluate the CE of ribociclib treatment in comparison to an NSAI, exemestane, paclitaxel and docetaxel treatments. The model was comprised of three stages as progression free survival, post-progression survival and death. The results of MONALEESA-7 trial were used for effectiveness data. An indirect comparison was made to compare the effectiveness of ribociclib treatment with exemestane, paclitaxel and docetaxel. Only direct costs were included in the model as per the requirements of the Social Security Institution (SSI). Costs were estimated based on expert views of resource use for treatment of adverse events, monitoring, disease progression terminal care and pre- and post- progression. Both costs and outcomes were discounted by 3%. ICER was calculated as the incremental cost per incremental life years (LY) as required by the SSI.

RESULTS: The ribociclib treatment estimated to yield 8.29 LYs. The incremental LY for comparators were 2.17, 2.33, 3.68 and 2.18 for an NSAI, exemestane, paclitaxel and docetaxel respectively. The incremental cost per incremental LY was 246,572 TRY for an NSAI treatment, 224,669 TRY for exemestane, 148,733 TRY for paclitaxel and 201,210 TRY for docetaxel. The sensitivity analyses indicated that the CE results were robust.

CONCLUSIONS: Turkey does not have an official threshold for decision-making. If the GDP per capita is taken into account (three times GDP per capita is 546,806TRY) ribociclib treatment for pre- and peri-menopausal women with HR+/HER2- ABC is a cost-effective option in Turkey.