First-line Treatment with Ribociclib plus Endocrine Therapy for Premenopausal Women with Hormone-receptor-positive Advanced Breast Cancer: A Cost-effectiveness Analysis.

Abstract Background We conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (MONALEESA-7) data to evaluate the cost-effectiveness of ribociclib (RIB) in the first-line treatment for premenopausal women with HR-positive and HER2-negative advanced breast cancer (ABC) from the US healthcare payer perspective. In addition, since RIB has not been marketed in China, we identified the range of drug costs for which RIB could be considered cost effective from a Chinese healthcare system perspective. Materials and Methods A Markov model was developed to evaluate the cost-effectiveness of adding RIB to endocrine therapy over a life-time horizon. The clinical outcomes and utility data were obtained from published literature. Costs data were obtained from the US and Chinese official websites and we assumed the possible price for RIB in China according to its price in the US. The main outcomes of this study were the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALY). Results The model projected that mean outcome was better with RIB & endocrine (3.83366 QALYs) than with endocrine therapy alone (2.71203 QALYs). In the US, RIB & endocrine therapy cost an additional $604,960.06, resulting in an ICER of $539,357.95/QALY compared with endocrine monotherapy. Subgroup analyses indicated in China, the projected mean outcomes were better for RIB & endocrine (6.37 QALYs) than for endocrine monotherapy (2.71QALYs). The corresponding incremental costs was $224,731.88943. Thus, the ICER comparing RIB & endocrine with endocrine was $61,454.96/QALY gained. Conclusions Additional use of RIB is estimated to not be cost-effective in the first-line treatment for premenopausal women with HR-positive, HER2-negative ABC in the US. A value-based price for the cost of RIB is less than $31.74/200mg for China, which can provide a reference for the listing of RIB in China.