Cost-Effectiveness Analysis of Abemaciclib plus Fulvestrant versus Placebo plus Fulvestrant in Patients with Hormone Receptor-Positive, ERBB2-Negative Breast Cancer

Abstract

<b><i>Purpose:</i></b> Abemaciclib is a selective and potent small-molecule inhibitor of cyclin-dependent kinase 4 and 6 (CDK4 and CDK6) which is administered orally. Compared to placebo plus fulvestrant (PF), abemaciclib plus fulvestrant (AF) significantly improved progression-free survival (PFS) and overall survival (OS). However, an economic evaluation of these two treatments is currently lacking. The purpose of this article was to evaluate the cost-effectiveness of the two treatments for HR+, HER2− advanced breast cancer (ABC) in the USA. <b><i>Methods:</i></b> A Markov simulation model was constructed using data from a published clinical trial (MONARCH 2). The two simulated treatment strategies included AF or PF. Costs were obtained from the clinical trials and the website, and utility was derived from the published literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the two treatment strategies. <b><i>Results:</i></b> The total costs were USD 400,377.43 and USD 89,937.77 for AF and PF treatment, respectively. The AF treatment produced 2.09 long-term quality-adjusted life years (QALYs), and the PF treatment produced 1.08 QALYs. Hence, patients who received AF treatment spent an additional USD 310,439.66 and generated an increase of 1.01 QALYs, resulting in an ICER of USD 307,366 per QALY. At current prices, AF was not cost-effective assuming a willingness-to-pay threshold of USD 150,000 per QALY gained. <b><i>Conclusion:</i></b> Despite significant gains in PFS over AF, it is not a cost-effective treatment for HR+, HER2− ABC in the USA at current drug prices.