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

Abstract

Background Dalpiciclib and abemaciclib, both CDK4/6 inhibitors, have been approved by the China National Medical Products Administration for the first-line treatment of postmenopausal women with hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2−) advanced breast cancer (ABC). As the first domestically developed CDK4/6 inhibitor in China, there has been no previous economic evaluation of dalpiciclib. This study aimed to assess the cost-effectiveness of dalpiciclib compared to abemaciclib when used in combination with letrozole for the first-line treatment of HR+/HER2 − ABC from the perspective of healthcare payers in China. Methods A Markov model with three health states was constructed to evaluate the health and economic outcomes of first-line treatment with dalpiciclib plus letrozole and abemaciclib plus letrozole for HR+/HER2 − ABC. The efficacy data was obtained from the MONARCH3 and DAWNA-2 trials, while utility data was derived from published reports. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses were performed to explore variations in the model results. Results Compared to abemaciclib plus letrozole, dalpiciclib plus letrozole resulted in 5.13 additional QALYs, with an ICER of $27,305/QALY. At a willingness-to-pay (WTP) threshold of the gross domestic product (GDP) per capita in China for 2022 ($38,223/QALY), the probability of dalpiciclib plus letrozole being cost-effective was 75%. Sensitivity analysis results were consistent with those of the base-case analysis. Conclusions From the perspective of Chinese healthcare payers, the combination of dalpiciclib and letrozole appears to be a more cost-effective strategy when compared to abemaciclib plus letrozole for the first-line treatment of patients with HR+/HER2 − ABC in China.