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. 2025 Apr 14;15(1):12765.
doi: 10.1038/s41598-025-97504-3.

Cost-effectiveness of CDK4/6 inhibitors for second-line HR+/HER2- advanced or metastatic breast cancer in China

Caifeng Jia  1 , Sen Zhang  2 , Jie Wang  3 , Bing Feng  4 , Fenghao Shi  5   6 , Meiqi Wang  7 , Sainan Li  7 , Hao Xu  8 , Mingxia Wang  9
Affiliations

Cost-effectiveness of CDK4/6 inhibitors for second-line HR+/HER2- advanced or metastatic breast cancer in China

Caifeng Jia et al. Sci Rep. .

Abstract

Hormone receptor HR-positive/HER2-negative (HR+/HER2-) breast cancer is the most common subtype in China, representing 60-70% of cases, with a rising incidence due to aging demographics and lifestyle changes. CDK4/6 inhibitors such as palbociclib, ribociclib and abemaciclib have been proven effective in treating HR+/HER2 - advanced or metastatic breast cancer (ABC/MBC), though they may increase healthcare costs. This study aims to compare the efficacy, safety and cost-effectiveness of CDK4/6 inhibitors for the second-line treatment of HR+/HER2 - ABC/MBC from the Chinese healthcare perspective. A cohort-based partitioned survival model was utilized, drawing on the survival data published from PALOMA-3, MONALEESA-3 and MONARCH-2 trials. Costs, and quality-adjusted life years (QALYs) were used to calculate the incremental cost-effectiveness ratio (ICER) over a 15-year time horizon. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model results. In the base-case analysis, the model estimated health benefits to be 2.10 QALYs for palbociclib plus fulvestrant (PAL + FUL), 2.55 QALYs for ribociclib plus fulvestrant (RIB + FUL), and 2.60 QALYs for abemaciclib plus fulvestrant (ABE + FUL), with corresponding costs of $34,423, $41,119, and $48,019. Compared with PAL + FUL, the ICERs were $27,161 per QALY for ABE + FUL and $15,073 per QALY for RIB + FUL. The robustness of these findings was confirmed through uncertainty analyses. Among the three strategies, the most cost-effective probabilities of PAL + FUL, RIB + FUL and ABE + FUL were 0%, 99.8%, and 0.2% under the willingness-to-pay (WTP) threshold of 3 times per-capita gross domestic product ($37,738) in China. This study indicated that both RIB + FUL and ABE + FUL are cost-effective at the WTP threshold compared with PAL + FUL. Notably, RIB + FUL offers the greatest cost-effective advantage for the second-line treatment of HR+/HER2 - ABC/MBC among these three CDK4/6 inhibitors.

Keywords: Breast cancer; CDK4/6 inhibitors; China; Cost-effectiveness; Fulvestrant; HR-positive/HER2-negative.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The data of the PFS/OS was based on previously published trials, and ethics approval or specific consent procedures were not applicable for this study.

Figures

Fig. 1
Fig. 1
Model structure of the PartSA model.
Fig. 2
Fig. 2
Tornado diagram of abemaciclib plus fulvestrant versus palbociclib plus fulvestrant. ABE, abemaciclib, PAL, palbociclib.
Fig. 3
Fig. 3
Tornado diagram of ribociclib plus fulvestrant versus palbociclib plus fulvestrant. RIB, ribociclib, PAL, palbociclib.
Fig. 4
Fig. 4
Tornado diagram of abemaciclib plus fulvestrant versus ribociclib plus fulvestrant. ABE, abemaciclib, RIB, ribociclib.
Fig. 5
Fig. 5
Scatter plots of costs and effectiveness for different treatment options.
Fig. 6
Fig. 6
Scatter plots of costs and effectiveness of abemaciclib plus fulvestrant versus palbociclib plus fulvestrant. ABE, abemaciclib, PAL, palbociclib.
Fig. 7
Fig. 7
Scatter plots of costs and effectiveness of ribociclib plus fulvestrant versus palbociclib plus fulvestrant. RIB, ribociclib, PAL, palbociclib.
Fig. 8
Fig. 8
Cost-effectiveness acceptability curve.
See this image and copyright information in PMC

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