COST-EFFECTIVENESS OF RIBOCILIB PLUS NONSTEROIDAL AROMATASE INHIBITOR (NSAI) IN HORMONE RECEPTOR–POSITIVE, HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2–NEGATIVE (HR+/HER2-) ADVANCED BREAST CANCER (ABC): A CANADIAN HEALTHCARE PERSPECTIVE
Author(s)
Stellato D1, Thabane M2, Chandiwana D3, Lanoue B3, Delea TE4
1Policy Analysis Inc. (PAI), Brookline, MA, USA, 2Novartis Oncology, Mississauga, ON, Canada, 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 4Policy Analysis Inc., Brookline, MA, USA
OBJECTIVES: The MONALEESA-7 trial demonstrated the efficacy and safety of ribociclib plus NSAI (R+NSAI) vs. placebo plus NSAI for pre-/peri-menopausal women with HR+/HER2- ABC who had received no prior endocrine therapy (ET) for advanced disease. This analysis evaluated the cost-effectiveness of R+NSAI vs. NSAI in this population from a Canadian healthcare payer perspective. METHODS: The incremental cost-effectiveness ratio (ICER) expressed as incremental costs per quality-adjusted life-year (QALY) gained for R+NSAI versus NSAI, was estimated using a semi-Markov cohort model developed in Microsoft Excel with states for progression-free (PF), post-progression (PP), and dead. A 15-year time horizon was used. Survival distributions for PFS, PPS and time to discontinuation (TTD) were based on parametric survival distribution fit to data from MONALEESA-7. Health-state utilities were estimated using EQ-5D index values collected in MONALEESA-7. Direct costs of ABC treatment (medication and administration costs, follow-up and monitoring, adverse events, subsequent treatments) were based on Canadian specific values from published sources. Costs ($ CAN) and QALYs were discounted at 1.5% annually. RESULTS: In the base case, R+NSAI was estimated to result in gains of 1.44 life years and 1.19 QALYs vs. NSAI, at an incremental cost of $210,767. The ICER of R+NSAI vs. NSAI was $177,245 per QALY gained based on deterministic analyses and $178,872 based on the mean of probabilistic analyses. Results were sensitive to parametric distributions used for projecting long-term TTD, PFS, and PPS. CONCLUSIONS: For pre-/peri-menopausal women with HR+/HER2- ABC who had received no prior ET for advanced disease, R+NSAI is projected to result in substantial gains in QALYs compared with NSAI. At its current list price, ribociclib used in combination with an NSAI is cost-effective in this population at an ICER threshold of approximately $177,245. These results may be useful in deliberations regarding reimbursement and access to this treatment.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PCN87
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology