Pluard Timothy J, Sandin Rickard, Parikh Rohan C, Ward Melea Anne, Stansfield Lindsay, Nham Tram, Esterberg Elizabeth, Cha-Silva Ashley S, Shah Bhavesh
Saint Luke's Cancer Institute, Kansas City, MO, USA.
Pfizer AB, Stockholm, Sweden.
Clinicoecon Outcomes Res. 2025 Mar 26;17:247-264. doi: 10.2147/CEOR.S496100. eCollection 2025.
To evaluate economic outcomes in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) treated with a first- or second-line cyclin-dependent kinase 4/6 inhibitor (CDK4/6i).
This retrospective analysis utilized Optum's Clinformatics DataMart (January 1, 2014-September 30, 2021). Included patients had ≥1 pharmacy claim for palbociclib, abemaciclib, or ribociclib in first or second-line and ≥6 months of continuous health plan enrollment in preindex (index: date of first CDK4/6i claim) and follow-up periods. Mean all-cause per patient per month (PPPM) medical, healthcare resource utilization (HCRU) and costs, and outpatient pharmacy prescriptions costs were compared among CDK4/6is using stabilized inverse probability of treatment weighting (sIPTW).
We identified 3,182 patients taking palbociclib, 286 taking abemaciclib, and 149 taking ribociclib, with median follow-ups of 20.8, 16.6, and 19.9 months, respectively. After sIPTW, palbociclib was associated with a lower risk of inpatient (IP) admissions versus abemaciclib (35.8% vs 41.6%; odds ratio: 1.31; =0.034). No other significant differences were seen for HCRU. PPPM outpatient costs were significantly lower with palbociclib versus abemaciclib ($754; =0.05). PPPM IP ($2,252 vs $6,286), medical ($6,948 vs $11,717), and total ($19,370 vs $23,639) costs were also lower with palbociclib versus abemaciclib, although not significant. There were no significant differences in PPPM HCRU or costs between palbociclib and ribociclib. In patients with Medicare, PPPM total medical costs were lower with palbociclib versus abemaciclib by $1,608 (=0.04), while other costs were not significantly different. No significant differences in costs were seen with palbociclib versus ribociclib.
All-cause HCRU and costs were generally not different between the CDK4/6is but favored palbociclib for medical (including IP) costs versus abemaciclib. Due to limited patient numbers, uncertainty exists about abemaciclib and ribociclib cost estimations. Further studies of HCRU and costs are needed to support a cost-minimizing strategy for mBC.
评估接受一线或二线细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）治疗的激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）转移性乳腺癌（mBC）患者的经济结局。
这项回顾性分析使用了Optum的临床信息数据集市（2014年1月1日至2021年9月30日）。纳入的患者在一线或二线治疗中有≥1次关于哌柏西利、阿贝西利或瑞博西利的药房索赔记录，并且在索引前（索引：首次CDK4/6i索赔日期）和随访期内有≥6个月的连续健康计划参保记录。使用稳定化逆概率治疗权重（sIPTW）比较了CDK4/6i之间每位患者每月的平均全因医疗、医疗保健资源利用（HCRU）和成本，以及门诊药房处方成本。
我们确定了3182例服用哌柏西利的患者、286例服用阿贝西利的患者和149例服用瑞博西利的患者，中位随访时间分别为20.8个月、16.6个月和19.9个月。经过sIPTW后，与阿贝西利相比，哌柏西利的住院（IP）入院风险较低（35.8%对vs%；优势比：1.31；P=0.034）。在HCRU方面未观察到其他显著差异。与阿贝西利相比，哌柏西利的门诊每月每位患者成本显著更低（754美元；P=0.05）。哌柏西利的IP（2252美元对6286美元）、医疗（6948美元对11717美元）和总（19370美元对23639美元）成本也低于阿贝西利，尽管差异不显著。哌柏西利和瑞博西利在每月每位患者的HCRU或成本方面没有显著差异。在医疗保险患者中，哌柏西利的每月每位患者总医疗成本比阿贝西利低1608美元（P=0.04），而其他成本没有显著差异。哌柏西利与瑞博西利在成本方面没有显著差异。
CDK4/6i之间的全因HCRU和成本总体上没有差异，但在医疗（包括IP）成本方面，哌柏西利优于阿贝西利。由于患者数量有限，阿贝西利和瑞博西利成本估计存在不确定性。需要进一步研究HCRU和成本，以支持mBC的成本最小化策略。
