ArticleJournal of managed care & specialty pharmacy2025
First-line cyclin-dependent kinase 4 and 6 inhibitors in combination with an aromatase inhibitor for HR+/HER2- metastatic breast cancer: A real-world cost-effectiveness assessment in a US Medicare-eligible population.
Article in Journal of managed care & specialty pharmacy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Cost-effectiveness analysis of first-line versus second-line use of CDK4/6 inhibitors combined with endocrine therapy in advanced HR+/HER2- breast cancer in China: based on the SONIA trial.Frontiers in pharmacology · 2025Article
- Cost-effectiveness analysis of inavolisib combined with palbociclib plus fulvestrant in PIK3CA-mutated HR+/Her2- advanced breast cancer in China.Frontiers in pharmacology · 2025Article
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Authors and funding
9 authors.
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Abstract
backgroundIn hormone receptor-positive, human epidermal growth factor 2-negative (HR+/HER2-) metastatic breast cancer (mBC), cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6is) in combination with an aromatase inhibitor (AI) are the preferred first-line (1L) treatment. Although prior cost-effectiveness models comparing CDK4/6is palbociclib, ribociclib, and abemaciclib have used data from placebo-controlled clinical trials, no analyses in the United States have been conducted using real-world evidence (RWE) for a US Medicare-eligible population.
objectiveTo estimate the long-term clinical outcomes and health care costs of 1L CDK4/6i treatment in patients aged 65 years and older using RWE.
methodsWe developed a partitioned survival model to project patient time in progression-free and progressed disease health states. Progression-free survival (PFS) and overall survival (OS) curves for palbociclib + AI were obtained from an analysis of patients aged 65 years and older treated 1L for HR+/HER2- mBC using the Flatiron Health Analytic Database (Flatiron). Adjusted comparative effectiveness estimates vs palbociclib + AI for both ribociclib + AI (PFS hazard ratio = 0.98 [95% CI = 0.86-1.13]; OS hazard ratio = 1.01 [95% CI: 0.87-1.18]) and abemaciclib + AI (PFS hazard ratio = 0.99 [95% CI = 0.86-1.15]; OS hazard ratio = 1.00 [95% CI = 0.84-1.19]) were obtained from the same analysis. All-cause medical costs and CDK4/6i drug costs were based on an analysis of patients aged 65 years and older in Optum Clinformatics DataMart. We used a Medicare perspective over a lifetime horizon for a cohort of patients with mean age of 73.7 years. Sensitivity analyses were performed to assess the robustness of results to plausible variation in input values.
resultsProjected life-years (LYs) with palbociclib + AI, ribociclib + AI, and abemaciclib + AI were similar: 5.16 (95% credible range [CR] = 4.94-5.35), 5.12 (95% CR = 4.53-5.82), and 5.16 (95% CR = 4.49-5.90), respectively. Total lifetime health care costs were also similar ($865,000 [95% CR = $807,400-$925,000], $866,800 [95% CR = $786,000-$965,000], and $901,000 [95% CR = $809,000-$1,004,600], respectively). Sensitivity analyses further supported no differences in LYs or total costs between CDK4/6is.
conclusionsBased on effectiveness and cost estimates from real-world data, our analyses suggest that palbociclib, ribociclib, and abemaciclib produce similar life expectancy and health care costs in US patients aged 65 years and older with HR+/HER2- mBC.
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