Cost-effectiveness comparison of dalpiciclib and abemaciclib combined with an aromatase inhibitor as first-line treatment for HR+/HER2− advanced breast cancer

ABSTRACT

Objectives

CDK4/6 inhibitors dalpiciclib and abemaciclib have been approved by the Chinese National Medical Products Administration as first-line treatment for postmenopausal females with hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2−) advanced breast cancer (ABC). We aimed to assess the cost-effectiveness of dalpiciclib plus letrozole/anastrozole (non-steroidal aromatase inhibitor [NSAI]) compared with abemaciclib plus NSAI as a first-line treatment for HR+/HER2− ABC in China.

Methods

We constructed a Markov model with three health states to evaluate health and economic outcomes of first-line treatment with dalpiciclib plus NSAI and abemaciclib plus NSAI for HR+/HER2− ABC. Efficacy data was obtained from MONARCH3 and DAWNA-2 trials. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated.

Results

Compared with abemaciclib plus NSAI, dalpiciclib plus NSAI resulted in 4.27 additional QALYs, with an ICER of $14827.4/QALY. At a willingness-to-pay threshold of 3 times gross domestic product per capita in China for 2023 ($37721.5/QALY), the cost-effectiveness probability of dalpiciclib plus NSAI was 77.42%.

Conclusions

From the perspective of Chinese payers, dalpiciclib plus NSAI appears to be a cost-effective strategy compared with abemaciclib plus NSAI for the first-line treatment of patients with HR+/HER2− ABC in China.

Clinical trial registration

MONARCH3, www.clinicaltrials.gov, identifier is NCT02246621 and DAWNA-2, www.clinicaltrials.gov, identifier is NCT03966898.

KEYWORDS:

• Abemaciclib
• aromatase inhibitor
• cost-effectiveness
• dalpiciclib
• HR+/HER2− advanced breast cancer

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contribution

Z Z Xia and J Meng conceived and designed the study protocol. L H Ouyang, N Du, A N Li, Z Q Zhou and H L Zhang retrieved and collected the data, T J Chen conducted the statistical analysis and interpretation of the results. J Hong completed the drafting of the article and interpretation of the results, J Hong, T J Chen, L H Ouyang revised the manuscript, Z Z Xia reviewed the manuscript. All authors read and approved the final manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2024.2330542.

Additional information

Funding

This paper was supported by Shenzhen High-level Hospital Construction Fund, Guangdong Pharmaceutical Association Comprehensive Drug Evaluation fund (Grant no. 2022-1115-29), and Shenzhen Pharmaceutical Association Hospital Pharmacy Research Fund (Grant no. sz2022A28), and China Medical Education Association Research Fund (Grant no. 2023WSJSPGZXKT-12). The sponsors had no roles in the study process.