Cost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a Brazilian public health care system perspective

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dc.contributor.authorRosa, Daniela Dornelles
dc.contributor.authorMagliano, Carlos Alberto da Silva
dc.contributor.authorSimon, Sergio D.
dc.contributor.authorAmorim, Gilberto
dc.contributor.authorReinert, Tomás
dc.contributor.authorLandeiro, Luciana
dc.contributor.authorGagliato, Débora de Melo
dc.contributor.authorExman, Pedro
dc.contributor.authorArgolo, Daniel
dc.contributor.authorGuilgen, Gisah
dc.contributor.authorMano, Max
dc.contributor.authorTesta, Laura
dc.contributor.authorLiedke, Pedro
dc.contributor.authorBarroso, Romualdo
dc.contributor.authorSasse, Mariana
dc.contributor.authorBuehler, Anna Maria
dc.date.accessioned2024-10-07T17:09:54Z
dc.date.available2024-10-07T17:09:54Z
dc.date.issued2022
dc.description.abstractIntroduction: The MONALEESA-7 trial compared ribociclib plus endocrine therapy (ET) with placebo as first-line treatment of advanced luminal/HER2-negative breast cancer (ABC) in premenopausal and perimenopausal women (age <50years) and showed significant benefits to progression-free survival and overall survival. This study aimed to compare the cost- effectiveness of ribociclib+ET versus ET alone in patients with ABC from the perspective of the Brazilian public national health system. Methods: We calculated the incremental cost-effectiveness ratio (ICER) using a Markov model with progression-free survival, post-progression survival, and death states. We expressed ICER as incremental costs per progression-free life-year (PFLY) and quality-adjusted life- year (QALY) gained in a 10-year time horizon. We used parametric survival distributions fit to MONALEESA-7 data to generate survival distributions for progression-free and post- progression survival. The largest British preference study in breast cancer served as the basis to estimate health-state utilities. We estimated direct costs (ABC treatment, follow-up, monitoring, and adverse events) using Brazilian-specific values from public sources. An expert consensus panel determined the resource patterns required. We applied annual discounts of 5% to costs and QALYs. Results: Ribociclib+ET resulted in an incremental gain of 1.03 PFLYs and 0.80 QALYs at a cost of $37,319.31. The ICER of ribociclib+ET versus ET was $36,379.41per PFLY gained and $46,590.79per QALY gained. In deterministic sensitivity analysis, results were primarily affected by the annual discount rate, followed by the cost of ribociclib. In probabilistic sensitivity analysis, simulations agreed with the base-case. Conclusion: Ribociclib increased PFLYs and QALYs in patients with HR+/HER2− ABC when added to ET. Because Brazil does not have a formally defined cost-effectiveness threshold, other domains need to be considered for incorporation decisions, such as disease burden and humanistic impact on this young, economically active population. These findings may be useful in discussions for incorporation of ribociclib into the Brazilian public health system.
dc.identifier.citationRosa DD, Magliano CADS, Simon SD, Amorim G, Reinert T, Landeiro L, Gagliato DM, Exman P, Argolo D, Guilgen G, Mano M, Testa L, Liedke P, Barroso R, Sasse M, Buehler AM. Cost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2- advanced breast cancer: a Brazilian public health care system perspective. Ther Adv Med Oncol. 2022 Jun 20;14:17588359221100865. doi: 10.1177/17588359221100865.
dc.identifier.otherDOI: 10.1177/17588359221100865.
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/473
dc.language.isoen
dc.publisherTherapeutic Advances in Medical Oncology
dc.subjectbreast canceren
dc.subjectCDK inhibitorsen
dc.subjectcost-effectivenessen
dc.subjectoverall survivalen
dc.subjectribocicliben
dc.titleCost-effectiveness of ribociclib for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a Brazilian public health care system perspective
dc.typeArticle
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