Cost-Effectiveness Analysis of Adding Palbociclib as a Second-Line Endocrine Therapy for HR+/HER2- Metastatic Breast Cancer From the US and Chinese Perspectives

Yingjie Zhang; Xiaohui Zeng; Haijun Deng; Fang Ma; Ye Peng; Lidan Yi; Chongqing Tan; Liubao Peng

doi:10.1016/j.clinthera.2019.04.033

Cost-Effectiveness Analysis of Adding Palbociclib as a Second-Line Endocrine Therapy for HR⁺/HER2^- Metastatic Breast Cancer From the US and Chinese Perspectives

Clin Ther. 2019 Jun;41(6):1175-1185. doi: 10.1016/j.clinthera.2019.04.033. Epub 2019 May 17.

Authors

Yingjie Zhang¹, Xiaohui Zeng², Haijun Deng³, Fang Ma⁴, Ye Peng⁵, Lidan Yi⁵, Chongqing Tan⁶, Liubao Peng⁵

Affiliations

¹ Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China; School of Mathematics and Statistics, Central South University, Changsha, China.
² PET-CT Center, The Second Xiangya Hospital, Central South University, Changsha, China.
³ Xiangya School of Public Health, Central South University, Changsha, China.
⁴ Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
⁵ Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.
⁶ Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China. Electronic address: tanchongqing@csu.edu.cn.

PMID: 31104762
DOI: 10.1016/j.clinthera.2019.04.033

Abstract

Purpose: As a second-line endocrine therapy for hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR⁺/HER2^-) metastatic breast cancer, palbociclib has demonstrated significant efficacy in prolonging progression-free survival when added to a regimen containing fulvestrant. The objective of this study was to evaluate the cost-effectiveness of palbociclib from the perspectives of the United States and China.

Methods: We developed a Markov model to estimate lifetime costs, overall life-years gained, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were performed to predict the uncertainty of the model developed. The time horizon was 10 years, and the perspective was that of the payer.

Findings: Within a 10-year time horizon, the palbociclib-containing strategy provided an additional 0.568 QALY, with an ICER of 88,854 USD/QALY, in the United States. When palbociclib cost 30%, 20%, and 10% of the current price, the ICERs were 185,526, 42,193, and 98,860 USD/QALY, respectively. In China, the ICER was 182,779 USD/QALY. When palbociclib cost 30%, 20%, and 10% of the current price, the ICERs were 79,558, 64,812, and 50,066 USD/QALY, respectively. In order to meet 50% probability of cost-effectiveness, the estimated price would have to be 32.52 USD/100 mg at a willingness-to-pay threshold of 58,480 USD/QALY (3 × per-capita domestic product of Beijing, China).

Implications: Adding palbociclib to a regimen of fulvestrant is unlikely to be cost-effective as a second-line endocrine therapy for HR⁺/HER2^- metastatic breast cancer (MBC) with at the current price in the United States and China. For widely meeting the treatment demands of patients, it may be a better option to decrease the price or provide more patients with a financial assistance program for palbociclib both in the United States and in China.

Keywords: cost-effectiveness; metastatic breast cancer; palbociclib; second-line endocrine therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Agents* / economics
Antineoplastic Agents* / therapeutic use
Breast Neoplasms* / drug therapy
Breast Neoplasms* / economics
China
Cost-Benefit Analysis
Female
Humans
Piperazines* / economics
Piperazines* / therapeutic use
Pyridines* / economics
Pyridines* / therapeutic use
Quality-Adjusted Life Years
United States

Substances

Antineoplastic Agents
Piperazines
Pyridines
palbociclib