Cost-Effectiveness of CDK4/6 Inhibitors (CDK4/6i) in First- vs Second-Line for Advanced Breast Cancer in the Phase 3 SONIA Trial (BOOG 2017-03)
Author(s)
Kent S1, Wortelboor N2, Konings IR3, van Ommen-Nijhof A3, van der Noort V4, van den Pol E5, Guerrero Paez C6, van Bekkum ML7, Droogendijk H8, Erdkamp F9, Houtsma D10, Oosterkamp HM11, van der Padt-Pruijsten A12, Siemerink EJM13, Tol J14, van Zweeden AA15, van Leeuwen-stok E16, Sonke GS4, Jager A2, Blommestein HM17
1Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, ZH, Netherlands, 2Erasmus Medical Centre, Rotterdam, ZH, Netherlands, 3Amsterdam University Medical Centres, Amsterdam, NH, Netherlands, 4Netherlands Cancer Institute, Amsterdam, NH, Netherlands, 5Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands, 6Dutch Breast Cancer Society, Utrecht, U, Netherlands, 7Reinier de Graaf Gasthuis, Delft, ZH, Netherlands, 8Bravis Hospital, Breda, Netherlands, 9Zuyderland Medical Center, Sittard-Geleen, ., Netherlands, 10Haga Hospital, The Hague, ZH, Netherlands, 11Haaglanden Medical Center, The Hague, ZH, Netherlands, 12Maasstad Hospital, Rotterdam, ZH, Netherlands, 13Ziekenhuis Groep Twente, Hengelo/Almelo, ., Netherlands, 14Jeroen Bosch Hospital, ’s-Hertogenbosch, ., Netherlands, 15Amstelland Hospital, Amstelveen, NH, Netherlands, 16BOOG Study Center,, Utrecht, U, Netherlands, 17Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, Netherlands
OBJECTIVES:
The phase 3 SONIA trial randomised 1,050 patients with ABC and found no significant difference in progression-free survival after two treatment lines between CDK4/6i in first- vs second-line in addition to aromatase-inhibitor in first- and fulvestrant in second-line. Health economic outcomes are currently unknown.METHODS:
A trial-based economic evaluation was conducted using survival, quality of life (EQ-5D-5L) and resource use data from SONIA. Individual EQ-5D scores were predicted in 3 month intervals using patients’ baseline characteristics, adverse events, and progression, stratified by treatment. Quality Adjusted Life Years (QALYs) were calculated by weighting survival curves by EQ-5D scores (Dutch tariffs). Healthcare resource use containing secondary care and medication use up to the end of SONIA treatment were costed using Dutch prices of 2024. In the base-case analysis, we estimated QALYs and costs up to 5-years using inverse probability of censoring weights and adjustment for baseline EQ-5D scores. We performed several sensitivity analyses including restriction to the period while on SONIA treatment.RESULTS:
In the base-case analysis, QALYs were similar in CDK4/6i first- vs second-line (2.69 [0.09] and 2.64 [0.08]; difference: -0.054, 95% CI -0.296 to 0.188). Costs were higher in the CDK4/6i first group (€61,821 [SD 1,358] versus €39,057 [SD 1,381]; difference: of €22,764, 95% CI €18,839 to €26,689) over 5 years, leading to an incremental cost-effectiveness ratio of €420,856 per QALY gained. Similar patterns were seen while on SONIA treatment for both QALYs (1.56 [0.04] and 1.53 [0.05] for CDK4/6i first vs second; difference: –0.030, 95% CI –0.159 to 0.101) and costs (€47,393 [1,154] and €24,125 [774] for CDK4/6i first vs second; difference: €23,268, 95% CI €20,254 to €20,759).CONCLUSIONS:
From a health economic perspective it is recommended to add CDK4/6i to second-line endocrine therapy instead of first-line. QALYs were similar but at substantially lower healthcare costs across all scenarios considered.Conference/Value in Health Info
Value in Health, Volume 27, Issue 12, S2 (December 2024)
Code
EE492
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology