Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Department of Pharmacy, Boai Hospital of Zhongshan, Zhongshan, China.
Expert Rev Pharmacoecon Outcomes Res. 2024 Apr;24(4):559-566. doi: 10.1080/14737167.2024.2330542. Epub 2024 Mar 20.
CDK4/6 inhibitors dalpiciclib and abemaciclib have been approved by the Chinese National Medical Products Administration as first-line treatment for postmenopausal females with hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC). We aimed to assess the cost-effectiveness of dalpiciclib plus letrozole/anastrozole (non-steroidal aromatase inhibitor [NSAI]) compared with abemaciclib plus NSAI as a first-line treatment for HR+/HER2- ABC in China.
We constructed a Markov model with three health states to evaluate health and economic outcomes of first-line treatment with dalpiciclib plus NSAI and abemaciclib plus NSAI for HR+/HER2- ABC. Efficacy data was obtained from MONARCH3 and DAWNA-2 trials. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated.
Compared with abemaciclib plus NSAI, dalpiciclib plus NSAI resulted in 4.27 additional QALYs, with an ICER of $14827.4/QALY. At a willingness-to-pay threshold of 3 times gross domestic product per capita in China for 2023 ($37721.5/QALY), the cost-effectiveness probability of dalpiciclib plus NSAI was 77.42%.
From the perspective of Chinese payers, dalpiciclib plus NSAI appears to be a cost-effective strategy compared with abemaciclib plus NSAI for the first-line treatment of patients with HR+/HER2- ABC in China.
MONARCH3, www.clinicaltrials.gov, identifier is NCT02246621 and DAWNA-2, www.clinicaltrials.gov, identifier is NCT03966898.
CDK4/6 抑制剂达尔西利和阿贝西利已被中国国家药品监督管理局批准用于治疗绝经后激素受体阳性（HR+）和人表皮生长因子受体-2 阴性（HER2-）的晚期乳腺癌（ABC）女性的一线治疗。我们旨在评估达尔西利联合来曲唑/阿那曲唑（非甾体芳香化酶抑制剂[NSAI]）与阿贝西利联合 NSAI 作为中国 HR+/HER2-ABC 的一线治疗的成本效益。
我们构建了一个具有三个健康状态的 Markov 模型，以评估达尔西利联合 NSAI 和阿贝西利联合 NSAI 一线治疗 HR+/HER2-ABC 的健康和经济结果。疗效数据来自 MONARCH3 和 DAWNA-2 试验。计算了质量调整生命年（QALYs）和增量成本效益比（ICERs）。
与阿贝西利联合 NSAI 相比，达尔西利联合 NSAI 可额外获得 4.27 个 QALYs，ICER 为 14827.4/QALY。在中国 2023 年人均国内生产总值的 3 倍作为支付意愿阈值（37721.5/QALY），达尔西利联合 NSAI 的成本效益概率为 77.42%。
从中国支付者的角度来看，达尔西利联合 NSAI 似乎是一种更具成本效益的策略，而不是阿贝西利联合 NSAI 用于中国 HR+/HER2-ABC 患者的一线治疗。
MONARCH3，www.clinicaltrials.gov，标识符为 NCT02246621 和 DAWNA-2，www.clinicaltrials.gov，标识符为 NCT03966898。
