Budget impact of including ribociclib in combination with letrozole on US payer formulary: first-line treatment of post-menopausal women with HR+/HER2− advanced or metastatic breast cancer. (2nd December 2018)

• Record Type: Journal Article
• Authors: Mistry, Rohit; Suri, Gaurav; Young, Kate; Hettle, Robert; May, Jessica R.; Brixner, Diana; Oderda, Gary; Biskupiak, Joseph; Tang, Derek; Bhattacharyya, Devarshi; Bhattacharyya, Subrata; Mishra, Dinesh; Dalal, Anand A.
• Is Part Of: Current medical research and opinion. Volume 34:Number 12(2018)
• Page Start: 2143
• Page End: 2150
• Publication Date: 2018-12-02
• Subjects: Ribociclib -- budget impact -- postmenopausal women -- hormone receptor-positive -- human epidermal growth factor receptor 2-negative -- advanced breast cancer -- metastatic breast cancer; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2018.1503484
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objectives: The combination of a cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitor with the aromatase inhibitor letrozole is a safe and effective alternative to letrozole monotherapy for first-line hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer. This study evaluates the budget impact of using the CDK 4/6 inhibitor ribociclib plus letrozole as a first-line treatment option for postmenopausal women with HR+/HER2− advanced breast cancer, from a United States (US) payer perspective. Methods: A cohort-based budget impact model was used to calculate the incremental cost of introducing ribociclib plus letrozole over three years for the target population. The analysis compared two scenarios: treatment options excluding or including ribociclib plus letrozole. Market shares were derived from market research and the assumption was the introduction of ribociclib plus letrozole would only displace existing CDK-based therapies. Treatment duration was based on the median time to treatment discontinuation or median progression-free survival for first-line treatment, and on clinical trial data for second- and third-line treatment. Acquisition costs were based on wholesale acquisition costs and considered co-payment. Costs for drug administration and monitoring, subsequent therapy, and relevant adverse events were included. Results: Of 1 million insured members, 263 were eligible for CDK 4/6 inhibitor treatment. Cumulative total savings with ribociclib plus letrozole were $3.01M over three years, corresponding to a cumulative incremental cost saving of $318.11 per member treated per month. Conclusions: In the US, ribociclib plus letrozole represents a cost-saving first-line treatment option for postmenopausal women with HR+/HER2− advanced breast cancer.