Abstract 463P
Background
Cyclin dependent kinase inhibitors (CDK 4/6) are the mainstay of treatment in metastatic Hormone receptor positive (HR+) HER-2 negative breast cancer, having impressive Progression free survival (PFS) and overall survival (OS) results. The approved agents are Palbociclib, Ribociclib and Abemaciclib. OS data are not yet mature for Abemaciclib. Cost effectiveness of these drugs has not been studied in the Indian context, where most patients resort to out of pocket expenditure (OOP). This study was undertaken to analyse the cost effectiveness of Palbociclib and Ribociclib by calculating the quality adjusted life years (QALY) and Incremental cost effective ratio (ICER).
Methods
Maximum retail price (MRP) of these drugs was obtained. PFS and OS were collected from the pivotal studies of these drugs. OS data not mature for Abemaciclib, hence not included. QALY and ICER was calculated using the formula QALY= [m PFS (years) x utility value (PFS)] + [ {m OS- m PFS} X utility value (PD)], where PD is progressive disease. QALY was calculated for CDK 4/6 inhibtor and control. Utility value for PFS and PD taken as 0.715 and 0.443 respectively, based on earlier studies. Gain of QALY= QALY of CDK 4/6- QALY of control Incremental cost= total cost of drug till PD or death ICER= Incremental cost/ gain of QALY Cost effectiveness was based on the WHO criteria - which is less than 3 x Gross domestic product (GDP) per capita India GDP per capita in 2020 is USD 1900 Hence cost effectiveness from an Indian perspective ought to be less than USD 5700.
Results
For Palbocilib QALY, gain of QALY, incremental cost and ICER/QALY were 2.53, 0.32, Rs 855000 (USD 11400) Rs 26, 41,334 (USD 35217) For Ribociclib QALY, gain of QALY, incremental cost and ICER/QALY were 2.92, 0.67, Rs 81000 (USD 10800) and Rs 12, 08,576 (USD 16,114).
Conclusions
Both Palbociclib and Ribociclib are not cost effective based on the WHO benchmark (six and three times higher respectively). Ribociclib has lower ICER/QALY compared to Palbociclib (USD 19103 lower), making it cost effective among the two. Based on its recent OS advantage and favourable ICER/QALY Ribocicilib can be preferred. Considering the clinical benefit of these drugs, cost effectiveness has to be improved to benefit the larger patient populace.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
439P - Evaluating Ewing’s sarcoma as the prototype for cancer care in teenage and young adults (TYA): A single-center retrospective cross-sectional study
Presenter: Pradeep Kumar Kistampally
Session: Poster viewing 06
440P - Targeting KRAS<sup>G12C</sup>: Repurposing of potential therapeutics for the treatment of pancreatic ductal adenocarcinoma (PDAC)
Presenter: EVA RAHMAN KABIR
Session: Poster viewing 06
441P - Malignant diseases diagnosed in people living with HIV in Japan
Presenter: Kenju Ando
Session: Poster viewing 06
442P - Dose intensity and tolerance of modified FOLFIRINOX in patients with advanced cancer
Presenter: Tejaswini Adadadara
Session: Poster viewing 06
444P - Incidence of cancer diagnosis and cancer care before and after the COVID-19 pandemic in French Polynesia TEAHUPOO study
Presenter: Elodie HIRIGOYEN
Session: Poster viewing 06
445P - Development of a simple and objective prognostication model in patients with advanced solid malignant tumor treated with immune checkpoint inhibitors: A pan-cancer analysis
Presenter: Yuto Matsushita
Session: Poster viewing 06
446P - Impact of previous immunotherapy on chemotherapy efficacy in metastatic melanoma
Presenter: Meiyu Fang
Session: Poster viewing 06
447P - Clinical characteristics of 21 patients with type 1 diabetes mellitus related to immune checkpoint inhibitors
Presenter: Haruna Kameoka
Session: Poster viewing 06
448P - Prevalence of thyroid dysfunction, diabetes, and impact of palliative chemotherapy in advanced metastatic cancer patients: Prospective data from LMIC
Presenter: Amit Sehrawat
Session: Poster viewing 06
449P - The study of androgen receptor status in triple negative breast cancer patients at Medical Oncology Department, Yangon General Hospital (YGH)
Presenter: Khin Mu
Session: Poster viewing 06