Davie Alison, Traoré Sory, Badreldin Waleed, Torstensson Astrid, Cakar Esra, McCullough Anuja C, Tempelaar Susan, Fenwick Elisabeth, Hall Peter S
Eli Lilly and Company Limited, Bracknell, UK.
Eli Lilly and Company Limited, Basingstoke, UK.
Adv Ther. 2025 Jun;42(6):2767-2781. doi: 10.1007/s12325-025-03164-0. Epub 2025 Apr 8.
The monarchE trial demonstrated that the addition of 2 years of abemaciclib to adjuvant endocrine therapy (ET) significantly reduced the risk of disease recurrence in patients with hormone receptor positive (HR+), and human epidermal growth factor receptor 2-negative (HER2-), node-positive early breast cancer (EBC) at high risk of disease recurrence. Abemaciclib meets a critical unmet need for more effective adjuvant therapy for this patient population. This study evaluates the cost-effectiveness (CE) of abemaciclib plus ET compared to ET alone.
A five-state cohort transition model, which presents a United Kingdom (UK) perspective, is parameterized using data from the monarchE trial and literature. Cost-effectiveness results are presented in terms of cost/quality-adjusted life year (QALY) over a lifetime time horizon. Various assumptions were tested through sensitivity and scenario analyses and uncertainty was assessed through probabilistic analysis.
Patients receiving abemaciclib plus ET were predicted to experience higher QALYs (11.16 compared to 10.42) at an increased cost (£87,541 compared to £48,625), leading to an incremental cost-effectiveness ratio (ICER) of £52,317 per QALY gain compared to ET alone. The increased costs associated with the addition of abemaciclib were partially offset by a reduction in distant disease recurrence and associated costs. The scenario and sensitivity analyses supported robust base case results.
Despite the ICER exceeding usual willingness-to-pay (WTP) levels in the UK, a consequence of using list prices, the CE model utilizing the latest data cut from the monarchE trial, demonstrated that the upfront cost of abemaciclib reduces the risk of a terminal breast cancer prognosis and its associated cost and quality of life impact. The addition of 2 years of abemaciclib provides an option for the treatment of HR+, HER2-, node-positive, high-risk EBC.
君主E试验表明，在辅助内分泌治疗（ET）基础上加用2年阿贝西利，可显著降低激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）、淋巴结阳性且疾病复发风险高的早期乳腺癌（EBC）患者的疾病复发风险。阿贝西利满足了这一患者群体对更有效辅助治疗的关键未满足需求。本研究评估了阿贝西利联合ET与单纯ET相比的成本效益（CE）。
采用五状态队列转换模型，该模型以英国视角呈现，使用君主E试验和文献中的数据进行参数化。成本效益结果以终身时间范围内的成本/质量调整生命年（QALY）表示。通过敏感性和情景分析测试各种假设，并通过概率分析评估不确定性。
预计接受阿贝西利联合ET治疗的患者QALY更高（分别为11.16和10.42），成本增加（分别为87,541英镑和48,625英镑），与单纯ET相比，每增加一个QALY的增量成本效益比（ICER）为52,317英镑。加用阿贝西利带来的成本增加部分被远处疾病复发及相关成本的降低所抵消。情景分析和敏感性分析支持了稳健的基础病例结果。
尽管ICER超过了英国通常的支付意愿（WTP）水平，这是使用标价的结果，但利用君主E试验最新数据的CE模型表明，阿贝西利的前期成本降低了晚期乳腺癌预后风险及其相关成本和生活质量影响。加用2年阿贝西利为HR+、HER2-、淋巴结阳性、高危EBC的治疗提供了一种选择。
