Abstract
Introduction
Abemaciclib is an oral inhibitor of cyclin-dependent kinases 4 and 6 (CDK4/6). Data from the clinical trial monarchE (2023) showed improved survival from invasive disease. The aim of the present article was to conduct an economic assessment of adjuvant treatment with abemaciclib in women with luminal, HER2- and node-positive breast cancer.
Methods
A Markov model was constructed with four mutually exclusive health states (disease-free, local recurrence, distal recurrence and death). Analyses were based on the clinical trial monarchE which compared an intervention group (abemaciclib + hormone therapy [HT]) with HT alone. The effectiveness measure used was quality-adjusted life years (QALY), with unit costs and utilities being obtained from existing literature. The incremental cost–utility ratio (ICUR) was used to compare the two treatment strategies.
Results
Total costs were €98,765 and €17,935 for the abemaciclib plus HT group and the HT alone group, respectively. The health outcome was 10.076QALY for the intervention group and 9.495QALY for the control group, with the ICUR being€139,173/QALY.
Conclusion
Despite the significant gains of abemaciclib as adjuvant treatment in terms of progression-free survival, this treatment is not cost-effective for the Spanish National Health System at published prices. It may be cost-effective with an appropriate discount on the official price.
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Data availability
The data has been extracted from publicly available sources as described in the corresponding bibliographic citations.
References
Red Española de Registros de Cáncer (REDECAN) y Sociedad Española de Oncología Médica (SEOM): REDECAN y SEOM elaboran una infografía sobre cáncer de mama en España para concienciar a la población sobre la importancia de la prevención, https://seom.org/images/NP_Cancer_de_Mama_SEOM_REDECAN_2022.pdf
Johnston, D., S, R., Harbeck, N., Hegg, R., Toi, M., Martin, M., Min Shao, Z., Yuan Zhang, Q., Luis Martinez Rodriguez, J., Campone, M., Hamilton, E., Sohn, J., Guarneri, V., Okada, M., Boyle, F., Neven, P., CortésCort, J., Huober, J., Wardley, A., Tolaney, S.M., Cicin, I., Smith, I.C., Frenzel, M., Headley, D., Wei, R., San Antonio, B., Hulstijn, M., Cox, J., Rastogi, P.: Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR1, HER22, node-positive, high-risk, early breast cancer (monarchE). J. Clin. Oncol. 38, 3987–3998 (2020). https://doi.org/10.1200/JCO.20
Johnston, S.R.D., Toi, M., O’Shaughnessy, J., Rastogi, P., Campone, M., Neven, P., Huang, C.S., Huober, J., Jaliffe, G.G., Cicin, I., Tolaney, S.M., Goetz, M.P., Rugo, H.S., Senkus, E., Testa, L., Del Mastro, L., Shimizu, C., Wei, R., Shahir, A., Munoz, M., San Antonio, B., André, V., Harbeck, N., Martin, M.: Abemaciclib plus endocrine therapy for hormone receptor-positive, HER2-negative, node-positive, high-risk early breast cancer (monarchE): results from a preplanned interim analysis of a randomised, open-label, phase 3 trial. Lancet Oncol. 24, 77–90 (2023). https://doi.org/10.1016/S1470-2045(22)00694-5
CHMP: Committee for Medicinal Products for Human Use (CHMP) Assessment report. Verzenrios. International non-propriestary name: abemaciclib. (2022)
Committee for Medicinal Products for Human Use (CHMP): Assessment report Verzenios International non-proprietary name: abemaciclib Procedure No. EMEA/H/C/004302/II/0013, https://www.ema.europa.eu/en/documents/variation-report/verzenios-h-c-004302-ii-0013-epar-assessment-report-variation_en.pdf
Orozco Leal, G., Armstrong, N., Kernohan, A., Ahmadu, C., Coughlan, D., McDermott, K., Duffy, S., O’Meara, S., Robinson, T., Vale, L., Kleijnen, J.: Abemaciclib in combination with endocrine therapy for adjuvant treatment of hormone receptor-positive, HER2-negative, node-positive early breast cancer: an evidence review group perspective of a NICE single technology appraisal. Pharmacoeconomics (2023). https://doi.org/10.1007/s40273-023-01259-6
Lopez Bastida, J., Oliva, J., Antonanzas, F., Garcia-Altes, A., Gisbert, R., Mar, J., Puig-Junoy, J.: A proposed guideline for economic evaluation of health technologies. Gac. Sanit. 24, 154–170 (2010). https://doi.org/10.1016/j.gaceta.2009.07.011
Naimark, D.M.J., Bott, M., Krahn, M.: The half-cycle correction explained: two alternative pedagogical approaches. Med. Decis. Making 28, 706–712 (2008)
Single Technology Appraisal Abemaciclib in combination with endocrine therapy for adjuvant treatment of hormone receptor-positive, HER2-negative, node-positive early breast cancer [ID3857] Committee Papers SINGLE TECHNOLOGY APPRAISAL Abemaciclib in combination with endocrine therapy for adjuvant treatment of hormone receptor-positive, HER2-negative, node-positive early breast cancer [ID3857] Contents. (2022)
Liu, N., Zhou, Y., Lee, J.J.: IPDfromKM: reconstruct individual patient data from published Kaplan-Meier survival curves. BMC Med. Res. Methodol. (2021). https://doi.org/10.1186/s12874-021-01308-8
Jongbloed, E.M., Blommestein, H.M., van Schoubroeck, H.M., Martens, J.W.M., Wilting, S.M., Groot, C.A.U.D., Jager, A.: Cost-Effectiveness of abemaciclib in early breast cancer patients: one size fits all or tailoring to patients’ needs? Breast Cancer: Targets Ther. 15, 147–161 (2023). https://doi.org/10.2147/BCTT.S387375
Latimer, N.R.: Survival analysis for economic evaluations alongside clinical trials—extrapolation with patient-level data: Inconsistencies, limitations, and a practical guide. Med. Decis. Making 33, 743–754 (2013). https://doi.org/10.1177/0272989X12472398
Pan, H., Gray, R., Braybrooke, J., Davies, C., Taylor, C., McGale, P., Peto, R., Pritchard, K.I., Bergh, J., Dowsett, M., Hayes, D.F.: 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N. Engl. J. Med. 377, 1836–1846 (2017). https://doi.org/10.1056/nejmoa1701830
Dannehl, D., Volmer, L.L., Weiss, M., Matovina, S., Grischke, E.M., Oberlechner, E., Seller, A., Walter, C.B., Hahn, M., Engler, T., Brucker, S.Y., Hartkopf, A.D.: Feasibility of adjuvant treatment with abemaciclib—real-world data from a large German breast center. J. Pers. Med. (2022). https://doi.org/10.3390/jpm12030382
Pagani, O., Walley, B.A., Fleming, G.F., Colleoni, M., Láng, I., Gomez, H.L., Tondini, C., Burstein, H.J., Goetz, M.P., Ciruelos, E.M.: Adjuvant exemestane with ovarian suppression in premenopausal breast cancer: long-term follow-up of the combined TEXT and SOFT trials. J. Clin. Oncol. 41, 1376–1382 (2023)
Cameron, D., Piccart-Gebhart, M.J., Gelber, R.D., Procter, M., Goldhirsch, A., de Azambuja, E., Castro, G., Untch, M., Smith, I., Gianni, L.: 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin adjuvant (HERA) trial. Lancet 389, 1195–1205 (2017)
National Cancer Institute: Surveillance, Epidemiology and End ResultsProgram. Cancer Stat Facts: Female Breast Cancer Subtypes., https://seer.cancer.gov/statfacts/html/breast-subtypes.html
Instituto Nacional de Estadística (INE): Life Tables Methodology, https://www.ine.es/en/metodologia/t20/t2020319a_en.pdf
Instituto Nacional de Estadistica (INE): Update a personal income or spending with the overall CPI (CPI system base 2021) for complete annual periods.
ORDEN de 14 de octubre de 2005, por la que se fijan los precios públicos de los servicios sanitarios prestados por Centros dependientes del Sistema Sanitario Público de Andalucía., https://juntadeandalucia.es/boja/2005/210/28
Orden de 8 de noviembre de 2016, por la que se modifica la Orden de 14 de octubre de 2005, por la que se fijan los precios públicos de los servicios sanitarios prestados por centros dependientes del Sistema Sanitario Público de Andalucía., https://juntadeandalucia.es/boja/2016/218/1
Gennari, A., André, F., Barrios, C.H., Cortés, J., de Azambuja, E., DeMichele, A., Dent, R., Fenlon, D., Gligorov, J., Hurvitz, S.A., Im, S.A., Krug, D., Kunz, W.G., Loi, S., Penault-Llorca, F., Ricke, J., Robson, M., Rugo, H.S., Saura, C., Schmid, P., Singer, C.F., Spanic, T., Tolaney, S.M., Turner, N.C., Curigliano, G., Loibl, S., Paluch-Shimon, S., Harbeck, N.: ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann. Oncol. 32, 1475–1495 (2021). https://doi.org/10.1016/j.annonc.2021.09.019
Consejería de salud de la Junta de Andalucía: Proceso Asistencial Integrado Cáncer de mama. (2011)
Di Cosimo, S., Porcu, L., Cardoso, F.: CDK 4/6 inhibitors mired in uncertainty in HR positive and HER2 negative early breast cancer. Breast 55, 75–78 (2021). https://doi.org/10.1016/j.breast.2020.12.006
National Institute for Health and Care Excellence: Abemaciclib with endocrine therapy for adjuvant treatment of hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence. Technology appraisal guidance [TA810], https://www.nice.org.uk/guidance/ta810
Agencia Española de Medicamentos y Productos Sanitarios: Informe de Posicionamiento Terapéutico de abemaciclib (Verzenios®) en mujeres con cáncer de mama localmente avanzado o metastásico, https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IPT_32-2019-abemaciclib-Verzenios.pdf?x14717
Mohammadpour, S., Soleimanpour, S., Javan-Noughabi, J., Gallehzan, N.A., Aboutorabi, A., Jahangiri, R., Bagherzadeh, R., Gorman, J.F., Nemati, A.: A systemmatic literature review on indirect costs of women with breast cancer. Cost Eff. Resour. Alloc. (2022). https://doi.org/10.1186/s12962-022-00408-6
Huang, M., Haiderali, A., Fox, G.E., Frederickson, A., Cortes, J., Fasching, P.A., O’Shaughnessy, J.: Economic and humanistic burden of triple-negative breast cancer: a systematic literature review. Pharmacoeconomics (2022). https://doi.org/10.1007/s40273-021-01121-7
European Medicine Agency: product-information/verzenios, https://www.ema.europa.eu/en/documents/product-information/verzenios-epar-product-information_en.pdf
Zhu, L., Wang, M., Luo, X., Li, H., Shan, H., Du, Q., Zhai, Q.: Pharmacoeconomic evaluations of CDK4/6 inhibitors plus endocrine therapy for advanced hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2−) breast cancer: a systematic review. Ann. Transl. Med. 10, 233–233 (2022). https://doi.org/10.2103/atm-21-5110
Loibl, S., Marmé, F., Martin, M., Untch, M., Bonnefoi, H., Kim, S.-B., Bear, H., McCarthy, N., Olivé, M.M., Gelmon, K., García-Sáenz, J., Kelly, C.M., Reimer, T., Toi, M., Rugo, H.S., Denkert, C., Gnant, M., Makris, A., Koehler, M., Huang-Bartelett, C., Frean, M.J.L., Colleoni, M., Werutsky, G., Seiler, S., Burchardi, N., Nekljudova, V., von Minckwitz, G.: Palbociclib for residual high-risk invasive HR-positive and HER2-negative early breast cancer-the penelope-B trial. J. Clin. Oncol. 39, 1518–1530 (2021). https://doi.org/10.1200/JCO.20.03639
Galactionova, K., Loibl, S., Salari, P., Marmé, F., Martin, M., Untch, M., Bonnefoi, H.R., Kim, S.B., Bear, H.D., McCarthy, N., Gelmon, K.A., García-Sáenz, J.A., Kelly, C.M., Reimer, T., Toi, M., Rugo, H.S., Gnant, M., Makris, A., Burchardi, N., Schwenkglenks, M.: Cost-effectiveness of palbociclib in early breast cancer patients with a high risk of relapse: results from the PENELOPE-B trial. Front. Oncol. (2022). https://doi.org/10.3389/fonc.2022.886831
Bae, Y.H.J., Mullins, C.D.: Do value thresholds for oncology drugs differ from nononcology drugs? J. Manag. Care Pharm. 20, 1086–1092 (2014)
Organization, W.H.: Technical report: pricing of cancer medicines and its impacts: a comprehensive technical report for the World Health Assembly Resolution 70.12: operative paragraph 2.9 on pricing approaches and their impacts on availability and affordability of medicines for the prevention and treatment of cancer. (2018)
Vallejo-Torres, L., García-Lorenzo, B., Castilla, I., Valcárcel Nazco, C., García-Pérez, L., Linertová, R., Serrano-Aguilar, P.: Valor Monetario de un Año de Vida Ajustado por Calidad: Estimación empírica del coste de oportunidad en el Sistema Nacional de Salud. Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación del Servicio Canario de la Salud: Informes d
Jenei, K., Raymakers, A.J.N., Bayle, A., Berger-Thürmel, K., Cherla, A., Honda, K., Jackson, C.C.G.A., Karikios, D., Trapani, D., Berry, S.: Health technology assessment for cancer medicines across the G7 countries and Oceania: an international, cross-sectional study. Lancet Oncol. 24, 624–635 (2023)
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Daysi Yoe-Ling Chang Chan (MD, PhD); Emily Caitlin Lily Knox (PhD)
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Fenix-Caballero, S., Sanchez-Vegas, A., Alegre Del-Rey, E.J. et al. Economic assessment of abemaciclib for the adjuvant treatment of luminal HER2- breast cancer from the perspective of the Spanish health system. Eur J Health Econ (2024). https://doi.org/10.1007/s10198-024-01681-3
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DOI: https://doi.org/10.1007/s10198-024-01681-3