Abstract

Objectives

Sacituzumab govitecan (SG) is a novel antibody-drug conjugate that targets Trophoblast cell-surface antigen 2 (Trop-2). It has been proved that the efficacy of SG is highly dependent on Trop-2 expression, with higher expression levels potentially correlating with better treatment outcomes. The cost-effectiveness analysis of SG in relapsed or refractory metastatic triple-negative breast cancer (mTNBC) in the varying Trop-2 levels from the perspective of payers is eagerly needed.

Methods

In this study, the cost and effectiveness of SG in patients with varying Trop-2 expression levels were explored. The partitioned survival model was then developed, followed by deterministic sensitivity analysis and probabilistic sensitivity analysis to assess the stability of the parameter values and assumptions used in the model.

Results

For patients with high Trop-2 expression, SG treatment gained 0.75 quality-adjusted life-years (QALYs) at a cost of $123 406, whereas single-agent chemotherapy treatment gained 0.41 QALYs at $1557. SG was significantly more expensive, resulting in an incremental cost-effectiveness ratio of $357 133/QALY, far above cost-effectiveness thresholds in Chinese Mainland ($12 734-$38 202). Thus, SG is not cost-effective for high Trop-2 expression mTNBC. Similarly, for patients with medium Trop-2 expression, the incremental cost-effectiveness ratio was $281 567/QALY, also exceeding the threshold. For patients with low Trop-2 expression, SG gained more LYs but fewer QALYs than single-agent chemotherapy treatment, making it not cost-effective compared with chemotherapy.

Conclusions

In conclusion, although SG is clinically effective for mTNBC, its high cost makes it economically unfeasible in mainland China. A substantial price reduction is essential for it to become a viable option, enabling more patients to benefit from its therapeutic potential.