The Cost-Effectiveness of CDK4/6 Inhibitors in Treating HR+/HER2- Metastatic Breast Cancer Patients in the USA: When Non-medication Expenses are Considered.

IF 2.9 3区医学 Q2 PHARMACOLOGY & PHARMACY Clinical Drug Investigation Pub Date : 2025-01-11 DOI:10.1007/s40261-024-01416-5

Asal Pilehvari, Wen You, Gretchen Kimmick, Fabian Camacho, Gloribel Bonilla, Roger Anderson

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Abstract

Background and objective: Cyclin-dependent kinase (CDK)4/6 inhibitors in combination with endocrine therapy (ET) significantly enhance progression-free survival and overall survival in patients diagnosed with HR+/HER2- metastatic breast cancer (MBC). However, they are highly expensive, and their economic impact has not been fully evaluated. This is a retrospective secondary analysis evaluating the cost effectiveness of these drugs, differentiating between medication-related and non-medication costs from a healthcare perspective.

Methods: We identified 3879 patients diagnosed with MBC who received either CDK4/6i+ET (N = 2137) or ET alone (N = 1742) as first-line treatment between February 2015 and November 2021 using a USA-wide electronic health record-derived de-identified database. SEER-Medicare claims spending data were used to quantify monthly costs as a supplement to the database. Relevant costs included prescribed medications (ET and/or CDK4/6i) and overall other costs. The effectiveness was measured as progression-free duration in months. The incremental cost effectiveness ratio (ICER) analysis was conducted to examine the cost effectiveness of first-line CDK4/6i as compared with first-line ET alone.

Results: For medication costs, CDK4/6i+ET (mean cost: $240,723.7; mean effect: 19.2 months of delayed progression) compared with ET alone (mean cost: $5159.7; mean effect: 16 months without progression) resulted in an ICER of $73,098 per month of delayed progression. For non-medication costs, CDK4/6i+ET (mean cost: $43,656.6) compared with ET alone (mean cost: $66,083.5) resulted in an ICER of - $7178 per month of delayed progression.

Conclusion: The cost of treating HR+/HER2- MBC is driven by the cost of CDK4/6i. Using CDK4/6i+ET reduces non-medication costs compared to ET alone, but these savings are offset by high CDK4/6i medication costs. Lowering the market cost of CDK4/6i or targeting those who can benefit the most could improve the cost effectiveness of CDK4/6i from Medicare perspective.

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CDK4/6抑制剂治疗美国HR+/HER2-转移性乳腺癌患者的成本-效果：考虑非药物费用

背景与目的：细胞周期蛋白依赖性激酶（CDK）4/6抑制剂联合内分泌治疗（ET）可显著提高HR+/HER2-转移性乳腺癌（MBC）患者的无进展生存期和总生存期。然而，它们非常昂贵，其经济影响尚未得到充分评估。这是一项回顾性的二次分析，评估这些药物的成本效益，从医疗保健的角度区分药物相关和非药物成本。方法：在2015年2月至2021年11月期间，我们使用美国范围内的电子健康记录衍生的去识别数据库，确定了3879名被诊断为MBC的患者，他们接受了CDK4/6i+ET （N = 2137）或单独接受ET （N = 1742）作为一线治疗。seer -医疗保险索赔支出数据用于量化每月费用，作为数据库的补充。相关费用包括处方药物（ET和/或CDK4/6i）和总体其他费用。疗效以无进展持续时间（月）衡量。采用增量成本效益比（ICER）分析，比较一线CDK4/6i治疗与一线ET治疗的成本效益。结果：在药物费用方面，CDK4/6i+ET(平均费用：240,723.7美元；平均效果：19.2个月延迟进展)与单独使用ET相比(平均成本：5159.7美元；平均效果：16个月无进展)导致延迟进展每月的ICER为73,098美元。对于非药物费用，CDK4/6i+ET（平均费用：43,656.6美元）与单独ET（平均费用：66,083.5美元）相比，导致每月延迟进展的ICER为- 7178美元。结论：治疗HR+/HER2- MBC的费用由CDK4/6i的费用驱动。与单独使用ET相比，使用CDK4/6i+ET可以减少非药物成本，但这些节省被高昂的CDK4/6i药物成本所抵消。从Medicare的角度来看，降低CDK4/6i的市场成本或针对那些最能受益的人群可以提高CDK4/6i的成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Drug Investigation 医学-药学

CiteScore

5.90

自引率

3.10%

发文量

108

审稿时长

6-12 weeks

期刊介绍： Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes: -Clinical trials, outcomes research, clinical pharmacoeconomic studies and pharmacoepidemiology studies with a strong link to optimum prescribing practice for a drug or group of drugs. -Clinical pharmacodynamic and clinical pharmacokinetic studies with a strong link to clinical practice. -Pharmacodynamic and pharmacokinetic studies in healthy volunteers in which significant implications for clinical prescribing are discussed. -Studies focusing on the application of drug delivery technology in healthcare. -Short communications and case study reports that meet the above criteria will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Clinical Drug Investigation may be accompanied by plain language summaries to assist readers who have some knowledge, but non in-depth expertise in, the area to understand important medical advances.