Palbociclib in hormone receptor positive advanced breast cancer: A cost-utility analysis.

Abstract

INTRODUCTION:

The addition of palbociclib to letrozole improves progression-free survival in the first-line treatment of hormone receptor positive advanced breast cancer (ABC). This study assesses the cost-utility of palbociclib from the Canadian healthcare payer perspective.

METHODS:

A probabilistic discrete event simulation (DES) model was developed and parameterised with data from the PALOMA 1 and 2 trials and other sources. The incremental cost per quality-adjusted life-month (QALM) gained for palbociclib was calculated. A time horizon of 15 years was used in the base case with costs and effectiveness discounted at 5% annually. Time-to- progression and time-to-death were derived from a Weibull and exponential distribution. Expected costs were based on Ontario fees and other sources. Probabilistic sensitivity analyses were conducted to account for parameter uncertainty.

RESULTS:

Compared to letrozole, the addition of palbociclib provided an additional 14.7 QALM at an incremental cost of $161,508. The resulting incremental cost-effectiveness ratio was $10,999/QALM gained. Assuming a willingness-to-pay (WTP) of $4167/QALM, the probability of palbociclib to be cost-effective was 0%. Cost-effectiveness acceptability curves derived from a probabilistic sensitivity analysis showed that at a WTP of $11,000/QALM gained, the probability of palbociclib to be cost-effective was 50%.

CONCLUSION:

The addition of palbociclib to letrozole is unlikely to be cost-effective for the treatment of ABC from a Canadian healthcare perspective with its current price. While ABC patients derive a meaningful clinical benefit from palbociclib, considerations should be given to increase the WTP threshold and reduce the drug pricing, to render this strategy more affordable.

• Authors: J Raphael, J Helou, K I Pritchard, D M Naimark
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 85 Pg. 146-154 (11 2017) ISSN: 1879-0852 [Electronic] England
• PMID: 28930692 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2017 Elsevier Ltd. All rights reserved.

Chemical References

• Antineoplastic Agents
• Aromatase Inhibitors
• Biomarkers, Tumor
• Nitriles
• Piperazines
• Protein Kinase Inhibitors
• Pyridines
• Triazoles
• Letrozole
• palbociclib

Topics

• Antineoplastic Agents (adverse effects, economics, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (economics, therapeutic use)
• Aromatase Inhibitors (economics, therapeutic use)
• Biomarkers, Tumor (analysis)
• Breast Neoplasms (chemistry, drug therapy, economics, pathology)
• Computer Simulation
• Cost-Benefit Analysis
• Decision Support Techniques
• Decision Trees
• Drug Costs
• Female
• Humans
• Letrozole
• Models, Economic
• Nitriles (economics, therapeutic use)
• Ontario
• Piperazines (adverse effects, economics, therapeutic use)
• Protein Kinase Inhibitors (adverse effects, economics, therapeutic use)
• Pyridines (adverse effects, economics, therapeutic use)
• Quality of Life
• Stochastic Processes
• Time Factors
• Treatment Outcome
• Triazoles (economics, therapeutic use)