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Pharmacoeconomic analysis of using cyclin-dependent kinase 4 and 6 inhibitors in the first line treatment of HR-positive HER2-negative advanced breast cancer

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors palbociclib, ribociclib and abemaciclib are the new treatment options for postmenopausal women with locally advanced or metastatic hormone-receptor (HR) positive human epidermal growth factor receptor 2 (HER2) negative BC. The aim of the current study is to conduct complex pharmacoeconomic evaluation of using CDK4/6 inhibitors palbociclib and ribociclib that are included in Vital and Essential Drug List (VEDL) in combination with letrozole in first line treatment from the Russian healthcare system prospective. Methods . Pharmacoeconomic evaluation consisted of two parts: clinical and economic study and budget impact analysis. We used cost minimization method for the clinical and economic study, since palbociclib and ribociclib are equally or comparably effective, according to earlier literature. Time horizon of clinical and economic study was 5 years. Direct medical costs including medications and adverse event treatments were considered. We accounted for treatment discontinuation and CDK4/6 inhibitors dose modifications. Budget impact analysis was performed for the three-year period of 2020-2022. All patients who can be treated with palbociclib or ribociclib were considered. Results . Mean direct medical costs of using palbociclib + letrozole were 2 082 333 RUB per patient, which were 505 016 RUB or 19.5% lower, compared to ribociclib + letrozole. According to current trends of BC morbidity, 8 098-8 221 newly diagnosed patients will be ready to start treatment with CDK4/6 inhibitors in 2020-2022 in Russia annually. Using palbociclib in this patient population lowers 3-year budget costs by 9 087 million RUB or by 22.5%, compared to ribociclib. Conclusions . Using palbociclib is the cost-saving treatment option for postmenopausal women with locally advanced or metastatic HR-positive HER2-negative BC, compared to ribociclib.