Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK).
Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system.
Institute of Pharmaceutical Medicine (ECPM), University Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland. klazien.matter@unibas.ch.|Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland. klazien.matter@unibas.ch.
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Matter-Walstra
Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.|Breast Centre, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St.Gallen, Switzerland.
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Ruhstaller
Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.
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Klingbiel
Institute of Pharmaceutical Medicine (ECPM), University Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
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Schwenkglenks
Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.|Department of Gynaecology, University Hospital Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000077289:Letrozole; D008390:Markov Chains; D009570:Nitriles / Q000191:economics / Q000627:therapeutic use*; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use*; D011725:Pyridines / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D013557:Switzerland; D016896:Treatment Outcome; D014230:Triazoles / Q000191:economics / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D000077289:Letrozole; D009570:Nitriles; D010879:Piperazines; D011725:Pyridines; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D014230:Triazoles; C508053:ERBB2 protein, human; C500026:palbociclib
Cost-effectiveness analysis; Letrozole; Metastatic breast cancer; Palbociclib