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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Breast Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1413676

Comparative Cost-Effectiveness Analysis of CDK4/6 Inhibitors in the First-Line Treatment of HR-Positive and HER2-Negative Advanced Breast Cancer: A Markov's Model-Based Evaluation

Provisionally accepted
Anas Hamad Anas Hamad 1,2*Shereen Elazzazy Shereen Elazzazy 1Nour H. Al-Ziftawi Nour H. Al-Ziftawi 2Mohamed Izham Mohamed Ibrahim Mohamed Izham Mohamed Ibrahim 2Salha B. AL Bader Salha B. AL Bader 1
  • 1 National Center for Cancer Care and Research, Doha, Qatar
  • 2 College of Pharmacy, Qatar University, Doha, Qatar

The final, formatted version of the article will be published soon.

    Introduction: 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. Objective: 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-2negativity versus one another and versus letrozole monotherapy. Methods: 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. Results: 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. Conclusion: 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.

    Keywords: breast cancer, Palbociclib, Ribociclib, Abemaciclib, Cost-Effectiveness

    Received: 07 Apr 2024; Accepted: 05 Jul 2024.

    Copyright: © 2024 Hamad, Elazzazy, Al-Ziftawi, Mohamed Ibrahim and AL Bader. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Anas Hamad, National Center for Cancer Care and Research, Doha, Qatar

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.