Cost-Effectiveness of Palbociclib in Hormone Receptor-Positive Advanced Breast Cancer
Menée aux Etats-Unis, cette étude analyse le rapport coût-efficacité du palbociclib en complément d'un traitement de référence chez les patientes atteintes d'un cancer du sein de stade avancé hormono-sensible
Background: Palbociclib, a novel small-molecule inhibitor of cyclin-dependent kinases 4 and 6 for the treatment of advanced breast cancer, has demonstrated significant efficacy in prolonging progression-free survival when added to existing therapies. Considering the high cost of palbociclib, we assessed cost-effectiveness of adding palbociclib to usual care in treatment of advanced breast cancer. Methods: We developed a discrete event simulation model to simulate time to cancer progression and to compare life time clinical benefit and cost of alternative treatment strategies for patients with metastatic disease from societal perspective. Per approved indication, endocrine treatment naive patients were assigned to palbociclib plus letrozole (PAL+LET) or letrozole alone (LET). Patients with prior endocrine therapy were assigned to palbociclib plus fulvestrant (PAL+FUL) or fulvestrant alone (FUL). The model assumptions were informed based on published clinical trial data and other peer reviewed studies. We performed one-way and probabilistic sensitivity analyses to assess the robustness of our results to the changes in model assumptions. Results: In treatment-naive patients, the addition of palbociclib to letrozole cost an estimated $768,498 per additional quality-adjusted life-year (QALY) gained. The addition of palbociclib to fulvestrant in patients with prior endocrine therapy cost an estimated $918,166 per QALY gained. Sensitivity analyses demonstrated adding palbociclib has a 0% chance of being cost-effectiveness in either patient groups at a willingness-to-pay threshold of $100,000 per QALY. Conclusion: From a societal perspective, palbociclib treatment for both patient groups (with and without prior endocrine therapy) is highly unlikely to be cost-effective compared with the usual care in the United States.