Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women

Gupta, Nidhi; Gupta, Dharna; Dixit, Jyoti; Mehra, Nikita; Singh, Ashish; Krishnamurthy, Manjunath Nookala; Jyani, Gaurav; Rajsekhar, Kavitha; Kalaiyarasi, Jayachandran Perumal; Roy, Partha; Malik, Prabhat Singh; Mathew, Anisha; Malhotra, Pankaj; Gupta, Sudeep; Kumar, Lalit; Kataki, Amal Chandra; Prinja, Shankar

doi:10.1007/s40258-022-00731-2

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…50 A recent study found the addition of ribociclib or palbociclib to fulvestrant for HR1/HER2-metastatic breast cancer to be cost-ineffective in India. 14 Similar to our study, a cost-effectiveness analysis from the societal Dutch perspective for HR1/HER2-EBC found abemaciclib to be cost-ineffective with an ICER of ₹5,608,450.21 ($67,159.03 USD)/QALY in the favorable scenario. 41 The addition of abemaciclib to ET was also not cost-effective for HR1/ HER2-EBC in the United States with an ICER of ₹34,888,822.83 ($417,780.18 USD)/QALY.…”

Section: Discussionsupporting

confidence: 87%

“…12,13 A cost-effectiveness analysis from India also revealed that both palbociclib and ribociclib are not cost-effective, for second-line treatment of advanced HR+ breast cancer, either at prevailing market prices or in government insurance reimbursement rates. 14 Although these studies show that CDK4/6 inhibitors are not cost-effective for HR+ advanced breast cancer, the cost-effectiveness of CDK4/6 inhibitors is not known for their use in adjuvant settings, especially from the perspective of LMICs.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Sra,

Sasi,

Batra

et al. 2024

JCO Glob Oncol

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PURPOSE Incorporating adjuvant cyclin-dependent kinase (CDK) 4/6 inhibitors abemaciclib and ribociclib along with endocrine therapy has been shown to improve invasive disease-free survival (iDFS) for hormone receptor–positive (HR+) human epidermal receptor 2–negative (HER2–) early breast cancer (EBC). This study assesses the cost-effectiveness of this strategy, along with adjuvant aromatase inhibitors from an Indian perspective. METHODS A Markov chain model evaluated the cost-effectiveness of abemaciclib and ribociclib with letrozole compared with letrozole alone for HR+/HER2– EBC from a payer perspective in India. Key measures included lifetime quality-adjusted life-years (QALY), life-years (LY), and total costs. This study explores two scenarios for effectiveness: a best-case (BC) scenario, where the benefit of CDK4/6 inhibitors in improving iDFS lasts a lifetime, and a worst-case (WC) scenario, where benefits disappear after 5 years. Probabilistic sensitivity analyses (PSA) were used to account for simulation uncertainty. RESULTS In the BC scenario, abemaciclib added 2.17 QALY and 4.96 LY, incurring ₹2,317,957.7 ($27,756.65 in US dollars [USD]) in additional costs. However, the incremental cost-effectiveness ratio (ICER) for abemaciclib exceeded India's willingness-to-pay threshold in the BC and WC scenarios. In the BC scenario, ribociclib added 0.98 QALY and 2.58 LY with added costs of ₹1,711,504.32 ($20,494.6 USD). The ICER for ribociclib also surpassed India's threshold in both scenarios. PSA showed that neither drug was cost-effective at the current market prices in either BC/WC scenario. The cost of abemaciclib and ribociclib needs to be reduced by at least 78.61% and 87.19%, respectively, to be cost-effective in the BC scenario. CONCLUSION The combination of adjuvant abemaciclib or ribociclib with letrozole is not cost-effective for HR+/HER2– EBC in India in either the BC or WC scenario.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Sra,

Sasi,

Batra

et al. 2024

JCO Glob Oncol

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“…The health benefits (QALYs) from crizotinib (2.73) and ceritinib (3.34) are significantly higher as compared with other molecules like sorafenib for hepatocellular carcinoma (0.5), 47 temozolomide (1.45) 25 and bevacizumab for metastatic cervical cancer (0.13), 48 and CDK4/6i (1.6) for breast cancer. 26 Hence, we recommend nearly 81% reduction in market price of crizotinib to make it a cost-effective treatment option to be included in India's publicly financed health insurance scheme.…”

Section: Discussionmentioning

confidence: 99%

“…Health system costs of outpatient consultation and day-care visits for PFS and PD patients were derived using data from published studies 25 , 26 and the nationally representative National Health System Cost Database (NHSCD). 27 The estimates on OOP expenditure were derived from primary data collected from 521 patients with advanced/metastatic NSCLC.…”

Section: Methodsmentioning

confidence: 99%

Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase– and ROS1 Fusion–Positive Non–Small Cell Lung Cancer in India

Gupta,

Singh

et al. 2024

JCO Glob Oncol

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PURPOSE Targeted therapies, such as crizotinib and ceritinib, have shown promising results in treating non–small cell lung cancer (NSCLC) with specific oncogenic drivers like anaplastic lymphoma kinase ( ALK), c-ros ( ROS1) oncogene, etc. This study aims to assess the cost-effectiveness of these therapies for patients with NSCLC in India. METHODS The Markov model consisted of three health states: progression-free survival, progressive disease, and death. Lifetime costs and consequences were estimated for three treatment arms: crizotinib, ceritinib, and chemotherapy for patients with ALK- and ROS1-positive NSCLC. Incremental cost per quality-adjusted life-year (QALY) gained with crizotinib and ceritinib was compared to chemotherapy and assessed using a willingness-to-pay threshold of one-time per capita gross domestic product in India. RESULTS The total lifetime cost per patient for ALK-positive NSCLC was ₹332,456 ($4,054 US dollars [USD]), ₹1,284,100 ($15,659 USD), and ₹2,337,779 ($28,509 USD) in the chemotherapy, crizotinib, and ceritinib arms, respectively. The mean QALYs lived per patient were 1.20, 2.21, and 3.34, respectively. For patients with ROS1-positive NSCLC, the total cost was ₹323,011 ($3,939 USD) and ₹1,763,541 ($21,507 USD) for chemotherapy and crizotinib, with mean QALYs lived per patient of 1.16 and 2.73, respectively. Nearly 92% and 81% reduction in the price of ceritinib and crizotinib is required to make it a cost-effective treatment option for ALK- and ROS1-positive NSCLC, respectively. CONCLUSION Our study findings suggest that the prices of ceritinib and crizotinib need to be reduced significantly to justify their value for inclusion in India's publicly financed health insurance scheme for treatment of patients with locally advanced/metastatic ALK- and ROS1-positive NSCLC, respectively.

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“…The fourth important implication of our study is generation of unit OOPE estimates, stratified by various clinical characteristics. These can be used along with health system cost database (39), to undertake oncology specific health technology assessments (40)(41)(42).…”

Section: Overall Summary Of Findingsmentioning

confidence: 99%

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Prinja

Dixit

Gupta

et al. 2023

Front. Public Health

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BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment.ConclusionThere is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

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Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women

Cited by 7 publications

References 43 publications

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor–Positive Early Breast Cancer: An Indian Perspective

Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase– and ROS1 Fusion–Positive Non–Small Cell Lung Cancer in India

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

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