Lang Yitian, Chai Qingqing, Lin Yan, Wu Bin, Liu Xiaoyan
Department of Pharmacy, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Pharmacol. 2025 Jan 15;15:1495082. doi: 10.3389/fphar.2024.1495082. eCollection 2024.
Capivasertib, a novel pan-AKT inhibitor, shows significant antitumor activity against hormone receptor-positive advanced breast cancer. However, its cost-effectiveness of this treatment remains uncertain. This study aimed to evaluate the cost-effectiveness of capivasertib plus fulvestrant versus fulvestrant alone for advanced breast cancer treatment from the perspectives of healthcare payers in the United States. Meanwhile, a experimental analysis from the perspective of China, incorporating specific assumptions, was also conducted in this study.
A partitioned survival model was constructed to project the progression of breast cancer. Overall survival (OS) and progression-free survival (PFS) data were obtained from the CAPItello-291 trial and extrapolated for long-term survival estimates. Direct medical costs and utility data were gathered. The primary outcome measure was incremental cost-utility ratio (ICUR) to evaluate the cost-effectiveness of treatment regimen. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of the results.
The base-case analysis estimated the ICUR for capivasertib plus fulvestrant versus fulvestrant alone to be $709,647 per quality-adjusted life-year (QALY) in the US. OWSA revealed that the results were sensitive to hazard ratio of OS and the cost of capivasertib. PSA demonstrated that capivasertib plus fulvestrant exhibited a 0% probability of cost-effectiveness in the US.
Our finding suggests that, at its current price, capivasertib plus fulvestrant regimen is unlikely to be a cost-effective option compared to fulvestrant alone for HR-positive advanced breast cancer patients from the perspective of healthcare system in the US. For the experimental analysis based on specific assumptions from Chinese perspective, the therapy regimen was also found to lack cost-effectiveness.
新型泛AKT抑制剂卡匹西利对激素受体阳性晚期乳腺癌显示出显著的抗肿瘤活性。然而，这种治疗的成本效益仍不确定。本研究旨在从美国医疗支付方的角度评估卡匹西利联合氟维司群与单独使用氟维司群治疗晚期乳腺癌的成本效益。同时，本研究还从中国的角度进行了纳入特定假设的实验性分析。
构建一个分区生存模型来预测乳腺癌的进展。总生存（OS）和无进展生存（PFS）数据来自CAPItello-291试验，并外推用于长期生存估计。收集直接医疗成本和效用数据。主要结局指标是增量成本效用比（ICUR），以评估治疗方案的成本效益。进行单向敏感性分析（OWSA）和概率敏感性分析（PSA）以评估结果的稳健性。
基础分析估计，在美国，卡匹西利联合氟维司群与单独使用氟维司群相比，每质量调整生命年（QALY）的ICUR为709,647美元。OWSA显示，结果对OS的风险比和卡匹西利的成本敏感。PSA表明，在美国，卡匹西利联合氟维司群显示出成本效益的概率为0%。
我们的研究结果表明，从美国医疗系统的角度来看，就目前的价格而言，对于激素受体阳性晚期乳腺癌患者，卡匹西利联合氟维司群方案与单独使用氟维司群相比不太可能是一种具有成本效益的选择。对于基于中国特定假设的实验性分析，该治疗方案也缺乏成本效益。
