WHAT IS THE CADTH REIMBURSEMENT RECOMMENDATION FOR VERZENIO?: CADTH recommends that Verzenio in combination with endocrine therapy should be reimbursed by public drug plans for the adjuvant treatment of adult patients with hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative, node-positive, early breast cancer at high risk of disease recurrence based on clinicopathological features and a Ki-67 score of at least 20% if certain conditions are met. WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE? Verzenio in combination with endocrine therapy should only be covered in patients whose breast cancer has receptors for the hormones estrogen and progesterone, tests negative for the HER2 protein, has been removed by surgery, and is at high risk of coming back based on certain risk features and the results of a biomarker test (i.e., Ki-67 test score ≥ 20%). WHAT ARE THE CONDITIONS FOR REIMBURSEMENT? Verzenio in combination with endocrine therapy should only be reimbursed if prescribed by clinicians with expertise in delivering systemic therapy and if the cost is reduced. WHY DID CADTH MAKE THIS RECOMMENDATION? Evidence from a clinical trial demonstrated that patients treated with Verzenio in combination with endocrine therapy experienced longer times until their cancer returned. Verzenio in combination with endocrine therapy meets patient needs for effective treatments that reduce the risk of their breast cancer coming back, maintain quality of life, have manageable side effects, and may be more accessible due to Verzenio’s oral route of administration. Verzenio in combination with endocrine therapy is not considered cost-effective compared to endocrine therapy alone. Economic evidence suggests that a 24% price reduction is needed to ensure Verzenio is cost-effective at a $50,000 per quality-adjusted life-year threshold. Based on public list prices, Verzenio is expected to cost the public drug plans $30,066,951 over 3 years.

ADDITIONAL INFORMATION

WHAT IS BREAST CANCER? Breast cancer begins in the cells of the breasts. Invasive early breast cancer without metastases has spread into the surrounding breast tissue but has not spread to different body parts. Approximately 94% of patients with HR-positive, HER2-negative early breast cancer survive at least 5 years. UNMET NEEDS IN BREAST CANCER: Patients with early breast cancer that has been removed by surgery but has a high risk to come back are in need of treatment options that prevent or delay the cancer from returning, prolong survival with an acceptable toxicity profile, and maintain quality of life. HOW MUCH DOES VERZENIO COST? Treatment with Verzenio is expected to cost approximately $5,514 per 28 days.