Work

Cost-effectiveness analysis of ribociclib versus abemaciclib as first-line treatments for postmenopausal women with HR+/HER2– advanced breast cancer: a Medicare perspective

Year: 2025

Type: article

Abstract: OBJECTIVE: This study aims to evaluate the cost-effectiveness of ribociclib versus abemaciclib as first-line (1 L) treatment among women with HR+/HER2- advanced breast cancer (aBC) from a Medicare perspective. METHODS: Using data from the MONALEESA-2 (ribociclib) and MONARCH 3 (abemaciclib) clinical trials and other sources, a partitioned survival model with states defined by progression-free survival (PFS) and overall survival (OS) was estimated over a lifetime horizon with a 28-day cycle length. Relative treatment efficacy was measured using PFS and OS HRs derived through an anchored matching adjusted indirect comparison. Incremental cost-effectiveness ratios (ICERs) were calculated with costs estimated from a Medicare perspective and effectiveness measured in terms of quality-adjusted life years (QALYs), life years (LYs), progression-free life years (PFLYs), equal value life years (evLYs), and health years in total (HYT). All measures of effectiveness and cost were discounted at 3%. A willingness-to-pay (WTP) threshold of $150,000 per QALY/evLY was used to evaluate cost-effectiveness. RESULTS: Measures of effectiveness were consistently higher for ribociclib versus abemaciclib with gains in QALYs (+0.81), LYs (+1.05), PFLYs (+0.65), evLYs (+0.93), and HYT (+1.05). Total costs to Medicare were 14.7% higher with ribociclib vs. abemaciclib ($487,715 vs $425,198, respectively). Ribociclib was cost-effective versus abemaciclib with estimated ICERs of $77,199 per QALY, $59,320 per LY, $96,829 per PFLY, $67,210 per evLY, and $59,624 per HYT gained. At a WTP threshold of $150,000 per evLY, the probability that ribociclib is cost-effective versus abemaciclib, which was 81%. CONCLUSION: Ribociclib improves health outcomes with a modest impact on costs and is likely to be more cost-effective than abemaciclib for postmenopausal women requiring 1 L treatment of HR+/HER2- aBC from a Medicare perspective.

Source: Journal of Medical Economics

DOI: 10.1080/13696998.2025.2594951