Economic Evaluation for Palbociclib Plus Fulvestrant vs Ribociclib Plus Fulvestrant and Abemaciclib Plus Fulvestrant in Endocrine-Resistant Advanced or Metastatic Breast Cancer in Italy

Giorgio Lorenzo Colombo; Maria Chiara Valentino; Alessandra Fabi; Maria Vittoria Dieci; Mauro Caruggi; Giacomo Matteo Bruno; Gloria Lombardi; Sergio Di Matteo

doi:10.2147/TCRM.S391769

Economic Evaluation for Palbociclib Plus Fulvestrant vs Ribociclib Plus Fulvestrant and Abemaciclib Plus Fulvestrant in Endocrine-Resistant Advanced or Metastatic Breast Cancer in Italy

Ther Clin Risk Manag. 2023 Mar 28:19:301-312. doi: 10.2147/TCRM.S391769. eCollection 2023.

Authors

Giorgio Lorenzo Colombo¹, Maria Chiara Valentino², Alessandra Fabi³, Maria Vittoria Dieci^{4

5}, Mauro Caruggi², Giacomo Matteo Bruno², Gloria Lombardi⁶, Sergio Di Matteo²

Affiliations

¹ Department of Drug Sciences, University of Pavia, Pavia, Italy.
² S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy.
³ Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, "A. Gemelli" IRCCS, Roma, Italy.
⁴ Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
⁵ Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
⁶ Real World Solutions, IQVIA Solutions Italy S.r.l, Milan, Italy.

Abstract

Background: To date, no study evaluated the cost-effectiveness of palbociclib (PAL) plus fulvestrant (FUL) vs ribociclib (RIB) plus FUL and abemaciclib (ABM) plus FUL in Italy. Cost-effectiveness analysis comparing the three cyclin-dependent 4/6 kinase inhibitors in combination with endocrine therapies for the management of postmenopausal women with HR+, HER2- advanced or metastatic breast cancer in Italy was developed.

Material and methods: To assess the cost-effectiveness of PAL plus FUL vs RIB plus FUL and ABM plus FUL, a cost-minimization has been carried out with a conservative scenario considering three CDK4/6 inhibitors with equal effectiveness in terms of overall survival (OS) (MAIC, Rugo et al 2021). Adverse events (AEs) associated with all therapies were obtained from clinical trials. Ad-hoc analysis was performed to estimate the cost-effectiveness considering the quality-of-life (QoL) data (Lloyd et al 2006).

Results: Cost-minimization inputs were drugs, visits and exams, AE monitoring and best supportive care (BSC) before the progression state, active and BSC in the progression and terminal phase of the last two weeks of life. Given the comparability of PAL, RIB and ABM in terms of efficacy, this analysis demonstrated slight economic savings over a lifetime for PAL. Results showed saving per patient of €305 (lifetime) when PAL is compared with RIB; for PAL vs ABM a saving of €243 (lifetime) in a conservative scenario. Results of a budget impact analysis showed a potential savings of €319,563 for PAL vs RIB and €297,544 for PAL vs ABM. When QoL data were considered, results may favor PAL due to the lower impact of AE with savings and improvement in the QoL related to fewer AE.

Conclusion: From the Italian perspective, a cost-saving profile associated with the use of PAL+FUL for the management of advanced/metastatic HR+/HER2- breast cancer compared to RIB+FUL and ABM+FUL emerged.

Keywords: Italy; abemaciclib; cost effectiveness; cost-minimization; metastatic breast cancer; palbociclib; ribociclib; second-line endocrine therapy.

Grants and funding

This analysis was sponsored by Pfizer, Italy.