Cost-effectiveness of adjuvant abemaciclib and ribociclib in high-risk, hormone receptor–positive, early breast cancer in India.

person Manraj Singh Sra All India Institute of Medical Science (AIIMS), New Delhi, India info_outline Manraj Singh Sra, Archana Sasi, Atul Batra, Sameer Bakhshi, Shuvadeep Ganguly

Authors person Manraj Singh Sra All India Institute of Medical Science (AIIMS), New Delhi, India info_outline Manraj Singh Sra, Archana Sasi, Atul Batra, Sameer Bakhshi, Shuvadeep Ganguly Organizations All India Institute of Medical Science (AIIMS), New Delhi, India, All India Institute of Medical Science, New Delhi, India, Department of Medical Oncology, BRA-IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India, All India Institute of Medical Sciences (AIIMS), New Delhi, India Abstract Disclosures Research Funding No funding sources reported Background: Incorporating adjuvant cyclin-dependent kinase (CDK) 4/6 inhibitors abemaciclib and ribociclib along with endocrine therapy has been shown to improve invasive disease-free survival (iDFS) for hormone receptor-positive (HR+) human epidermal receptor 2 negative (HER2-) early breast cancer (EBC). This study assesses the cost-effectiveness of this strategy, along with adjuvant aromatase inhibitors (AI) from an Indian perspective. Methods: A Markov chain model evaluated the cost-effectiveness of abemaciclib and ribociclib with letrozole compared to letrozole alone for HR+/HER2- EBC from a payer perspective in India. Key measures included lifetime quality-adjusted life years (QALY), life-years (LY), and total costs. This study explores two scenarios for effectiveness: a best-case (BC) scenario, where the benefit of CDK4/6 inhibitors in improving iDFS lasts a lifetime, and a worst-case (WC) scenario, where benefits disappear after 5 years. Probabilistic sensitivity analyses (PSA) were used to account for simulation uncertainty. Results: In the BC scenario, abemaciclib added 2.17 QALY and 4.96 LY, costing $27,756.65 more. Ribociclib in the BC scenario added 0.98 QALY and 2.58 LY, with added costs of $20,494.6. The incremental cost-effectiveness ratio for abemaciclib and ribociclib surpassed the willingness to pay threshold for in India in both scenarios (Table). At current market prices there is 0% probability of cost-effectiveness of abemaciclib and ribociclib. The cost of abemaciclib and ribociclib needs to be reduce by 78.61% and 87.19%, respectively to achieve cost-effectiveness. Conclusions: The combination of adjuvant abemaciclib or ribociclib with letrozole is not cost-effective for HR+/HER2- EBC in India in either the best or worst-case scenario. Health and economic outcomes. Parameters Best Case Scenario Worst Case Scenario Intervention Arm Control Arm Difference Intervention Arm Control Arm Difference Abemaciclib QALY 12·8 10·63 2·17 11·34 10·63 0·71 LY 22·87 17·92 4·96 19·2 17·92 1·29 Cost (USD) $34480.71 $6724.06 $27756.65 $35290.51 $6724.06 $28566.45 ICER QALY (USD/QALY) $12794.39 $40236.66 ICER LY (USD/LY) $5600.62 $22165.41 NMB (USD) -$22620.7 -$26885.68 Ribociclib QALY 14·49 13·51 0·98 13·76 13·51 0·25 LY 27·13 24·55 2·58 25·18 24·55 0·63 Cost (USD) $25744.02 $5249.42 $20494.6 $26074.71 $5249.42 $20825.29 ICER QALY (USD/QALY) $20927.21 $82763.6 ICER LY (USD/LY) $7932.94 $32943.76 NMB (USD) -$18176.13 -$20229.6 ICER QALY : Incremental Cost Effectiveness Ratio (ICER) for gain in quality associated life years; ICER LY : ICER for gain in life years; NMB: Net Monetary Benefit.