ISSN: 1859 - 2872
Cost-effectiveness of ribociclib plus endocrine therapy in premenopausal and perimenopausal women with advanced HR-positive/HER2-negative breast cancer
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Abstract
Objective: To evaluate the cost-effectiveness of ribociclib in combination with a non-steroidal aromatase inhibitor (NSAI) plus goserelin versus NSAI plus goserelin alone for the treatment of premenopausal patients with advanced HR+/HER2- breast cancer in Vietnam. Subject and method: A cost-effectiveness analysis was conducted using a hypothetical cohort of premenopausal and perimenopausal women with advanced HR+/HER2- breast cancer. A partitioned survival model with three health states (progression-free, progressed disease, and death) was adopted with a 28-day cycle length, lifetime time horizon, and payer perspective of the Vietnamese Social Health Insurance (SHI). Model inputs were sourced from published literature and expert consultation. Result: Compared with NSAI + goserelin, adding ribociclib yielded an additional 1.44 QALYs at an incremental cost of VND 630 million, resulting in an ICER of VND 438 million per QALY gained (≈3.8 times GDP per capita in 2024). Assuming SHI co-payment levels of 80%, 70%, and 60%, ICERs decreased to 363, 325 and 288 million VND/QALY, corresponding to 3.2, 2.9 and 2.5 times GDP per capita, respectively. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of ≥ 433 million VND/QALY, the probability of cost-effectiveness exceeds 50%. Conclusion: Ribociclib plus NSAI and goserelin is unlikely to be cost-effective under full reimbursement. However, under a 60 - 80% SHI co-payment scheme, the ICER falls below 3.2 times GDP per capita - approaching commonly accepted thresholds in Vietnam. Therefore, ribociclib may be considered a conditionally cost-effective option under a shared reimbursement mechanism.
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References
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