Cost-Utility of the CDK 4/6 Inhibitors for Postmenopausal Women With Luminal Advanced Breast Cancer in Brazil

thumbnail.default.alt
Data
2022
Autores
Macedo, Luana Schroeder Damico Nascimento
Silva, Aline Silveira
França, Ana Cláudia Wekmuller
Magliano, Carlos Alberto da Silva
Meirelles, Isandra
Padilla, Matheus Piccin
Santos, Marisa da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Value in Health Regional Issues
Resumo
Objectives: Several trials have demonstrated the benefit of the CDK 4/6 inhibitors for postmenopausal women with luminal advanced breast cancer. This research aims to compare the cost-utility of the CDK 4/6 inhibitors in patients with no history of resistance to endocrine therapy. Methods: A Markov model was constructed to estimate the incremental cost per quality-adjusted life-years (QALYs) of treatments from the Brazilian public health system perspective over a lifetime horizon (30 years) with 5% annual discount rate for both benefits and costs. Efficacy parameters were extracted from the pivotal studies. Costs were based on open data from the Brazilian Ministry of Health. The utilities were calculated according to the overall population preferences from a British study. Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. Results: The most cost-effective drug was ribociclib (US$50 748/QALY), followed by abemaciclib (US$64 052/QALY) and palbociclib (US$65 289/QALY). The univariate analysis showed that the incremental cost-utility ratio (ICUR) was mainly sensitive to the overall survival hazard ratio. The one thousand–probabilistic simulation showed that all ICUR values were above classical thresholds such as 1 to 3 gross domestic product (GDP) per capita per QALY. Conclusions: Even though there is no established willingness to pay threshold in Brazil, the estimated ICUR for CDK 4/6 in- hibitors is .6 times the Brazilian GDP per capita (GDP per capita = US$5694.73), which might be a barrier to their inclusion in the Brazilian public health system.
Description
Palavras-chave
advanced breast cancer, CDK 4/6 inhibitors, cost-utility analysis, economic models
Citação
Schroeder Damico Nascimento Macedo L, Silveira Silva A, Wekmuller França AC, Alberto da Silva Magliano C, Meirelles I, Piccin Padilla M, da Silva Santos M. Cost-Utility of the CDK 4/6 Inhibitors for Postmenopausal Women With Luminal Advanced Breast Cancer in Brazil. Value Health Reg Issues. 2022 Sep;31:47-52. doi: 10.1016/j.vhri.2022.02.006.