Cost-Effectiveness Analysis of Early Versus Delayed Use of Abemaciclib Combination Treatment in Patients with HR+/HER2- High-Risk Early Breast Cancer: A US Payer Perspective
Author(s)
Chang SH, Wang HM, Wang Y, Wilson DL, Shao H, Park H
University of Florida, College of Pharmacy, Gainesville, FL, USA
Presentation Documents
OBJECTIVES:
Clinical guidelines recommend use of abemaciclib, a cyclin-dependent kinase 4 and 6 inhibitor, in combination with endocrine therapy (ET) as adjuvant treatment for patients with hormone receptor-positive (HR+), HER2-negative (HER2-) early breast cancer (EBC) at high risk of recurrence or in combination with fulvestrant if patients develop metastatic breast cancer (MBC). We evaluated the cost-effectiveness of early use of abemaciclib and ET combination as first-line adjuvant therapy and then use of fulvestrant after developing MBC (early use) versus ET treatment in EBC followed by delayed use of combination abemaciclib and fulvestrant in MBC (delayed use).METHODS:
A Markov model was developed to estimate the 10-year health (quality-adjusted life years [QALYs]) and economic outcomes for early versus delayed use of abemaciclib combination treatment in patients with HR+/HER2- and high-risk (Ki-67 score ≥20%) EBC from a US payer’s perspective. Five health states were included: EBC progression-free, progressed disease, MBC progression-free, MBC-progression, and death. Effectiveness and safety data were derived from monarchE trial and MONARCH 2 trial. Utilities, disutility values of adverse events, and costs were derived from published sources and studies. Incremental cost-effectiveness ratios (ICERs) were calculated for early use relative to delayed use. Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the model robustness.RESULTS:
ICER of early use compared with delayed use was $119,285 per QALY gained. PSA indicated 51.4% and 61.1% probabilities of early use of abemaciclib combination therapy being cost-effective at the $150,000 and $200,000 per QALY wiliness-to-pay-thresholds, respectively. Results were most sensitive to variations in abemaciclib costs.CONCLUSIONS:
Early use of abemaciclib and ET combination as first-line adjuvant therapy in EBC followed by fulvestrant in MBC is likely to be a cost-effective strategy for patients with HR+/HER2- high-risk EBC compared to delayed use of combination abemaciclib considering acceptable willingness-to-pay thresholds of oncology drugs.Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
EE183
Topic
Economic Evaluation, Patient-Centered Research, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Health State Utilities, Trial-Based Economic Evaluation
Disease
Drugs