Cost-Effectiveness Analysis of Fulvestrant 500 mg in Endocrine Therapy-Naïve Postmenopausal Women with Hormone Receptor-Positive Advanced Breast Cancer in the UK

Abstract

IntroductionThe selective estrogen receptor degrader fulvestrant is approved for the first-line treatment of postmenopausal patients with hormone receptor-positive (HR+), locally advanced or metastatic breast cancer who have not received prior endocrine therapy. We evaluated the cost-effectiveness of fulvestrant versus comparator treatments in endocrine therapy-naïve patients with locally advanced or metastatic breast cancer.MethodsA three-health-state (progression free, progressed disease, and death) partitioned survival model from the UK National Health Service and Personal Social Services perspective was developed to extrapolate study data for the cumulative probability of progression-free survival and overall survival to a lifetime (30-year) horizon. Relative comparator data were derived from a systematic literature review-informed network meta-analysis. Sensitivity analyses were applied to assess the impact of uncertainty in the parameter input values on the results.ResultsOver a lifetime horizon (30 years), the incremental cost (British pounds sterling) per patient associated with fulvestrant treatment was £18,867 versus anastrozole, £23,097 versus letrozole, and £17,131 versus tamoxifen, with incremental quality-adjusted life-years of 0.55, 0.77, and 0.76, respectively, and incremental cost-effectiveness ratios of £34,109, £29,827, and £22,532, respectively. The largest difference in costs between fulvestrant and the comparators was related to treatment costs.ConclusionsResults suggest that fulvestrant could potentially be a cost-effective option compared with other endocrine monotherapies (anastrozole, letrozole, and tamoxifen) for treating endocrine therapy-naïve, postmenopausal women with HR+, locally advanced or metastatic breast cancer.Electronic supplementary materialThe online version of this article (10.1007/s41669-019-0134-3) contains supplementary material, which is available to authorized users.

Palbociclib sensitizes ER-positive breast cancer cells to fulvestrant by promoting the ubiquitin-mediated degradation of ER-α via SNHG17/Hippo-YAP axis

“…Although endocrine therapy has reasonably lessened recurrence and mortality in breast cancer, acquired resistance to this treatment still limits the therapeutic efficiency, and new therapeutic strategies to overcome this resistance are in urgent need. Fulvestrant, a selective estrogen receptor degrader of endocrine therapy drugs, is approved as the first- or second-line treatment for postmenopausal female with ER-positive breast cancer who has no response to tamoxifen [ 28 – 30 ]. Clinical studies have demonstrated that fulvestrant dramatically improved the progression-free survival of patients [ 6 , 31 – 33 ].…”

The use of fulvestrant before chemotherapy improves survival in hormone-positive breast cancer: a real-life study

“…Fulvestrant is a feasible and cost-effective treatment option in advanced breast cancer. 11 Although a variety of clinical trials in different treatment lines were available, the real-life data is limited. The real-life setting is very different from the clinical trials due to more unfit patients and more patients treated in the later lines due to physician preferences or reimbursement reasons.…”

Systematic Review of the Cost Effectiveness of Breast Cancer Prevention, Screening, and Treatment Interventions

“…Eighteen articles estimated the cost effectiveness of therapies in the metastatic setting, including chemotherapy (n = 8), hormone receptor-targeted treatment (n = 2), HER2-targeted treatment (n = 2), and targeted (biologic) therapy (n = 6). [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Eight articles estimated the cost effectiveness of chemotherapeutic agents. 54,55,57,60,63,65,71,72 Four studies showed that the addition of palbociclib, a chemotherapy agent used for the treatment of hormone receptor-positive and HER2-negative breast cancer, had cost-effectiveness ratios that exceeded the US WTP threshold of $100,000 per QALY.…”

“…55 Two articles estimated the cost effectiveness of fulvestrant, a hormonal treatment of advanced breast cancer, and each article found it to be cost effective in comparison with exemestane (aromatase inhibitor), letrozole (aromatase inhibitor), or tamoxifen at WTP thresholds in Sweden and the United Kingdom. 61,70 The cost effectiveness of HER2-targeted interventions for metastatic treatment exceeded the US WTP threshold of $100,000. 56,59 For example, the ICERs of trastuzumab emtansine were $183,828 per QALY compared with lapatinib plus capecitabine and $126,001 per QALY compared with capecitabine alone.…”

“…However, several industry-sponsored costeffectiveness analyses of metastatic regimens showed favorable results. 48,52,54,55,61,[67][68][69][70][73][74][75] Overall Summary…”