Cost-utility analysis of sacituzumab govitecan versus chemotherapy for the treatment of metastatic triple-negative breast cancer in Singapore

ABSTRACT

Objective

To assess the cost-effectiveness of sacituzumab govitecan for treating relapsed or refractory metastatic triple-negative breast cancer (TNBC) in Singapore.

Methods

A three-state partitioned survival model was developed to evaluate the cost-effectiveness of sacituzumab govitecan from a healthcare system perspective over 5 years. Clinical inputs were obtained from the ASCENT trial. Health state utilities were retrieved from the literature and direct costs were sourced from public healthcare institutions in Singapore. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties and assumptions on cost-effectiveness results.

Results

Compared with single-agent chemotherapy, sacituzumab govitecan was associated with a base-case incremental cost-effectiveness ratio (ICER) of S$328,000 (US$237,816) per quality-adjusted life year (QALY) gained. One-way sensitivity analyses showed that the ICER was most sensitive to the cost of sacituzumab govitecan and progression-free utility values. Regardless of variation in these parameters, the ICER remained high, and a substantial price reduction was required to reduce the ICER.

Conclusion

At its current price, sacituzumab govitecan does not represent a cost-effective treatment for relapsed or refractory metastatic TNBC in Singapore. Our findings will be useful to inform funding decisions alongside other factors including clinical effectiveness, safety, and budget impact considerations.

KEYWORDS:

• Cost-effectiveness
• partitioned survival analysis
• sacituzumab govitecan
• triple-negative breast cancer
• oncology

Declaration of interest

All authors declare that they have no competing interest.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2291155

Reviewer disclosures

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

Author contributions

BPC and SG developed the economic model, performed the analyses, collected, reviewed the data, interpreted the results, and drafted the manuscript. MIAZ, GW, BSKO and KN reviewed the data, interpreted the results, and revised the manuscript. RN provided clinical input and validated model assumptions.

Acknowledgments

The authors would like to thank Teresa Vaccaro for her assistance in editing the manuscript.

Additional information

Funding

This paper was not funded.