Elazzazy Shereen, Al-Ziftawi Nour Hisham, Mohamed Ibrahim Mohamed Izham, Bujassoum Salha, Hamad Anas
Pharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar.
Pharmacy Department, Aman Hospital, Doha, Qatar.
Front Oncol. 2024 Jul 24;14:1413676. doi: 10.3389/fonc.2024.1413676. eCollection 2024.
CDK4/6 inhibitors are the first-line treatment for HR+/HER2- advanced breast cancer. Despite their clinical benefit, they can increase healthcare expenditure. To date, there is no thorough comparison among the three approved CDK4/6 inhibitors in terms of their cost-effectiveness.
To investigate and compare the cost-effectiveness of CDK4/6 inhibitors in combination with letrozole as a first-line treatment for advanced breast cancer with hormonal-receptor-positivity and HER-2-negativity versus one another and versus letrozole monotherapy.
A 10-year within-cycle-corrected Markov's model was employed from the healthcare payer perspective. Costs were obtained from the National Center for Cancer Care and Research (NCCCR) in Qatar. Utilities and transition probabilities were calculated from published landmark trials of PALOMA-2, MONALEESA-2, MONARCH-3, PO25, and other relevant literature. Costs, measured in Qatari Riyal (QAR), and effectiveness, measured in quality-adjusted-life-years (QALYs), were incremented and the incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay threshold (WTP) of 1.5 Qatari GDP (448,758 QAR). A deterministic sensitivity analysis was implemented to account for uncertainties.
Ribociclib was the most effective option, generating 4.420 QALYs, followed by palbociclib (4.406 QALYs), abemaciclib (4.220 QALYs), then letrozole monotherapy (2.093 QALYs). As for cost-effectiveness, ribociclib dominated palbociclib. However, it was not cost-effective compared to abemaciclib (ICER=1,588,545 QAR/QALY). Ribociclib remained dominant over palbociclib with all uncertainties. The base-case conclusion of ribociclib versus abemaciclib remained robust over all uncertainties.
From the healthcare payer perspective in Qatar, ribociclib is the most effective CDK4/6 inhibitor. It was dominant over palbociclib in terms of cost-effectiveness; however, it was not cost-effective compared to abemaciclib at current prices.
细胞周期蛋白依赖性激酶4/6（CDK4/6）抑制剂是激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）晚期乳腺癌的一线治疗药物。尽管它们具有临床益处，但会增加医疗费用。迄今为止，在三种已获批的CDK4/6抑制剂之间，尚未就其成本效益进行全面比较。
研究并比较CDK4/6抑制剂联合来曲唑作为激素受体阳性、HER-2阴性晚期乳腺癌一线治疗方案，相互之间以及与来曲唑单药治疗相比的成本效益。
从医疗保健支付方的角度，采用了一个经过周期校正的10年马尔可夫模型。成本数据来自卡塔尔国家癌症护理与研究中心（NCCCR）。效用值和转移概率根据PALOMA-2、MONALEESA-2、MONARCH-3、PO25等已发表的标志性试验以及其他相关文献计算得出。以卡塔尔里亚尔（QAR）衡量的成本和以质量调整生命年（QALY）衡量的有效性进行增量计算，并将增量成本效益比（ICER）与1.5倍卡塔尔国内生产总值（448,758 QAR）的支付意愿阈值（WTP）进行比较。实施了确定性敏感性分析以应对不确定性。
瑞博西尼是最有效的选择，产生4.420个QALY，其次是哌柏西利（4.406个QALY）、阿贝西利（4.220个QALY），然后是来曲唑单药治疗（2.093个QALY）。至于成本效益，瑞博西尼优于哌柏西利。然而，与阿贝西利相比，它不具有成本效益（ICER = 1,588,545 QAR/QALY）。在所有不确定性情况下，瑞博西尼仍优于哌柏西利。瑞博西尼与阿贝西利比较的基本结论在所有不确定性情况下都保持稳健。
从卡塔尔医疗保健支付方的角度来看，瑞博西尼是最有效的CDK4/6抑制剂。在成本效益方面，它优于哌柏西利；然而，按照当前价格，与阿贝西利相比，它不具有成本效益。
