Pharmacoeconomic evaluation of ribociclib as first-line treatment in premenopausal women with HR+/HER2-advanced or metastatic breast cancer

ZHANG Sen; WANG Jie; LI Sai-nan; WANG Mei-qi; JU Ying-bo; WANG Ming-xia; JIA Cai-feng

doi:10.20251/j.cnki.1003-3734.2025.16.014

Abstract：Objective:To assess the cost-effectiveness of ribociclib combined with endocrine therapy versus endocrine therapy alone for premenopausal patients with HR+/HER2-advanced or metastatic breast cancer from the perspective of the Chinese healthcare system,providing references for healthcare decision-making.Methods:Based on the clinical efficacy data from the phase Ⅲ MONALEESA-7 trial,a partitioned survival model was constructed with a cycle length of four weeks and a time horizon of 20 years.The model evaluated differences in total costs,life years(LYs),quality-adjusted life years(QALYs),and incremental cost-effectiveness ratio(ICER)between ribociclib combined with endocrine therapy and endocrine therapy alone in terms of long-term health and economic benefits.The model's robustness was tested using one-way sensitivity analysis,probabilistic sensitivity analysis,and scenario analysis.Results:The base case analysis indicated that ribociclib combined with endocrine therapy was clinically superior to endocrine therapy alone,providing an additional 0.86 QALYs at an incremental cost of CNY234 623.99,with an ICER of 272 632.70 CNY·QALY-1.One-way sensitivity analysis showed that the three most influential factors on ICER were the utility value of progression-free survival,discount rate,and cost of ribociclib.The results of the probabilistic sensitivity analysis indicate that when the willingness-to-pay(WTP)threshold was set at three times the per capita GDP of China in 2023(268074 CNY·QALY-1),the probability of the ribociclib combined endocrine therapy regimen being cost-effective was 45％.Scenario analysis showed that with longer simulation time horizons,the ICER of the ribociclib combined with endocrine therapy gradually decreased,with the magnitude of decrease diminishing.Conclusion:At a WTP of 268074 CNY·QALY-1,ribociclib combined with endocrine therapy is not cost-effective compared to endocrine therapy alone for the first-line treatment of premenopausal patients with HR+/HER2-advanced or metastatic breast cancer.