Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis

Abstract

Background: Sacituzumab govitecan (SG) has recently been approved in China for the post-line treatment of metastatic triple-negative breast cancer (mTNBC). SG substantially improves progression-free survival and overall survival compared with single-agent chemotherapy for pretreated mTNBC. However, in view of the high price of SG, it is necessary to consider its value in terms of costs and outcomes. This study aimed to estimate the cost-effectiveness of SG versus single-agent treatment of physician's choice (TPC) in the post-line setting for patients with mTNBC from a Chinese healthcare system perspective.

Methods: The cohort characteristics were sourced from the ASCENT randomized clinical trial, which enrolled 468 heavily pretreated patients with mTNBC between November 2017 and September 2019. A partitioned survival model was constructed to assess the long-term costs and effectiveness of SG versus TPC in the post-line treatment of mTNBC. Quality-adjusted life-months (QALMs) and total costs in 2022 US dollars were used to derive incremental cost effectiveness ratio (ICER). QALMs and costs were discounted at 5% annually. The willingness-to-pay (WTP) threshold was defined as $3188 per QALM, three times China's average monthly per capita gross domestic product in 2022. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed to estimate the robustness of the results.

Results: Treatment with SG yielded an incremental 5.17 QALMs at a cost of $44,792 per QALM, much above the WTP threshold of $3188/QALM in China. One-way sensitivity analysis showed that SG price was a crucial factor in the ICER. Probabilistic sensitivity analysis revealed that the cost-effective acceptability of SG was 0% in the current setting. Scenario analyses indicated that the result was robust in all subgroups in ASCENT or under different time horizons. Furthermore, SG must reduce the price to enter the Chinese mainland market. When the monthly cost of SG reduce to $2298, SG has about 50% probability to be a preferred choice than TPC.

Conclusions: SG was estimated to be not cost-effective compared with TPC for post-line treatment for mTNBC in China by the current price in HK under a WTP threshold of $3188 per QALM. A drastic price reduction is necessary to improve its cost-effectiveness.

Keywords: Cost-effectiveness analysis; Metastatic triple-negative breast cancer; Sacituzumab govitecan; Single-agent chemotherapy.

Fig. 1

Partitioned survival model diagram. (Note: mTNBC, metastatic triple-negative breast cancer; SG, sacituzumab govitecan; TPC, treatment of physician’s choice; PFS, progression-free survival; PD, progressed disease; P, partitioned survival analysis)

Fig. 2

State membership in a 3-state partitioned survival model. (Note: OS, overall survival; PFS, progression-free survival)

Fig. 3

Tornado diagram of one-way sensitive analysis. (Note: SG, Sacituzumab govitecan; TPC, single-agent chemotherapy of physician’s choice; ICER, incremental cost-effectiveness ratio)

Fig. 4

Cost-effective acceptability curves of SG and TPC. (Note: SG, Sacituzumab govitecan; TPC, single-agent chemotherapy of physician’s choice; WTP, willing-to-pay; QALM, quality adjusted life month)