J Raphael1, J Helou2, K I Pritchard3, D M Naimark4. 1. University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada; Department of Oncology, Western University, London Regional Cancer Program, London, ON, Canada. Electronic address: raphaeljack13@hotmail.com. 2. University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada; Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada. 3. University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada. 4. University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Department of Medicine, Division of Nephrology, Toronto, ON, Canada.
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.
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: Jesús Isaac Vázquez-Serrano; Rodrigo E Peimbert-García; Leopoldo Eduardo Cárdenas-Barrón Journal: Int J Environ Res Public Health Date: 2021-11-22 Impact factor: 3.390
Authors: Katya Galactionova; Sibylle Loibl; Paola Salari; Frederik Marmé; Miguel Martin; Michael Untch; Hervé R Bonnefoi; Sung-Bae Kim; Harry D Bear; Nicole McCarthy; Karen A Gelmon; José A García-Sáenz; Catherine M Kelly; Toralf Reimer; Masakazu Toi; Hope S Rugo; Michael Gnant; Andreas Makris; Nicole Burchardi; Matthias Schwenkglenks Journal: Front Oncol Date: 2022-09-05 Impact factor: 5.738