Analysis of Ribociclib Finds it is Not Cost-Effective Despite Significant Survival Benefit

Ribociclib is approved for use in combination with an aromatase inhibitor for the first-line treatment of pre- and perimenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. Researchers evaluated the cost-effectiveness of ribociclib in this patient population and found that although it significantly improved overall survival and progression-free survival compared with endocrine therapy alone, it was not cost-effective at a willingness-to-pay threshold $100,000 or $150,000 per quality-adjusted life-years (QALYs) in the United States. The results of the study were presented during AMCP eLearning Days in a poster presentation titled “Evaluating the Cost-Effectiveness of Adding Ribociclib to Endocrine Therapy for Patients with HR-Positive, HER2-Negative Advanced Breast Cancer Among Premenopausal or Perimenopausal Women.”

Researchers conducted a cost-utility analysis from a U.S. payer perspective using a partitioned survival model with three health states (progression-free, progressed disease, and death) over a 20-year time horizon. All costs were measured in 2019 U.S. dollars, and a 3% annual discount rate was applied. Effectiveness was measured in QALYs by adjusting gained life years with health state utilities.

In the base case scenario, ribociclib plus endocrine therapy was associated with an average total cost of $433,958 and 4.09 QALYs, while endocrine therapy alone cost $44,795 and 2.69 QALYs. The incremental cost-effectiveness ratio for ribociclib plus endocrine therapy compared with endocrine therapy alone was $279,534 per QALY. One-way deterministic sensitivity analysis showed that the wholesale acquisition price of ribociclib was a main model sensitive driver. At a willingness-to-pay threshold of $268,800, ribociclib plus endocrine therapy would surpass endocrine therapy alone as a cost-effective option.

Jeong E, Nguyen V, Ngo H, Gu D, Zhong L. Evaluating the Cost-Effectiveness of Adding Ribociclib to Endocrine Therapy for Patients with HR-Positive, HER2-Negative Advanced Breast Cancer Among Premenopausal or Perimenopausal Women. Abstract C24. Presented during AMCP eLearning Days, April 20-24.