COST EFFECTIVENESS OF RIBOCICLIB PLUS LETROZOLE VERSUS PALBOCICLIB PLUS LETROZOLE FOR THE TREATMENT OF POST-MENOPAUSAL WOMEN WITH HORMONE RECEPTOR-POSITIVE (HR+), HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2-NEGATIVE (HER2-) ADVANCED OR METASTA ...
Author(s)
Suri G1, Mistry R1, Young KC1, Hettle R1, May JR1, Brixner D2, Oderda G2, Biskupiak J2, Tang D3, Bhattacharyya D4, Bhattacharyya S4, Mishra D4, Dalal A3
1PAREXEL International, London, UK, 2Milcreek Outcomes Group, Salt Lake City, UT, USA, 3Novartis, East Hanover, NJ, USA, 4Novartis, Hyderabad, Telangana, India
OBJECTIVES: To assess the cost effectiveness of ribociclib+letrozole (Rib) versus palbociclib+letrozole (Pal) for the first-line treatment of post-menopausal women with HR+/HER2- advanced or metastatic breast cancer using a US third-party payer perspective (commercial). METHODS: The lifetime costs and effectiveness of treatment were simulated using a cohort-based, three-state (progression-free [PF], progressed disease [PD], and death) partition survival model with a one-month cycle length. Clinical data were derived from the MONALEESA-2 trial of Rib and a meta-analysis of Pal studies. Cost inputs included costs for wholesale drug acquisition excluding co-payment (28-day treatment cycle price: $10,950, $8,760, and $4,380 for ribociclib 600mg, 400mg and 200mg, respectively, versus $10,963 for palbociclib [all strengths]), administration (Medicare physician fee schedule), disease monitoring, adverse events (treatment-related Grade 3+), and subsequent therapies. The impact of discontinuation and dose reduction on drug costs were considered for both therapies. Effectiveness was valued in quality-adjusted life years (QALYs), with utility weights derived from EQ-5D-5L data collected in MONALEESA-2 for PF and from the literature for PD. Costs and effects were discounted at 3.0% per year. Uncertainty was assessed via deterministic and probabilistic sensitivity analyses. RESULTS: At lifetime, the total cost of Rib was $432,095 (drug cost=$228,801; health state cost=$203,294) versus $475,132 ($256,509 and $218,623, respectively) for Pal. The QALYs for Rib were 3.07 (PFS=2.17; PD=0.90) versus 2.99 (PFS=1.99; PD=1.00) for Pal. Rib was less costly (-$43,037) and more effective (+0.086 QALY) than Pal, and was hence the dominant strategy. The probability that Rib was cost-effective versus Pal at $50,000 per QALY was 72.5%. Differences in drug acquisition costs were the key driver of results. CONCLUSIONS: In the US, Rib is a cost-effective alternative to Pal for first-line treatment of post-menopausal women with HR+/HER2- advanced or metastatic breast cancer.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCN133
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology