ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1540088
Cost-effectiveness analysis of CDK4/6 inhibitors in the second-line treatment for HR+/HER2-advanced or metastatic breast cancer
Provisionally accepted
- 1Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
- 2Shandong University, Jinan, Shandong Province, China
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Objective: The aim of this study was to compare the cost-effectiveness of various CDK4/6 inhibitors plus fulvestrant with fulvestrant monotherapy in the second-line treatment for patients with HR+/HER2− advanced or metastatic breast cancer from the Chinese healthcare system perspective. Methods: A partitioned survival model was established to investigate the total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over a 10-year lifetime horizon. Clinical data was derived from the MONARCH 2 trial, PALOMA 3 trial and MONALEESA 3 trial；direct medical costs and utilities were acquired from local charges and published literature. Scenario, one-way and probabilistic sensitivity analyses were performed to test the robustness of the model. Results: In the base-case analysis, abemaciclib plus fulvestrant, palbociclib plus fulvestrant, ribociclib plus fulvestrant resulted in ICERs of $3,636.51/QALY, $1,256.32/QALY, and $39,654.78/QALY, respectively, compared with fulvestrant monotherapy. In the pairwise comparison between three CDK4/6 inhibitors, abemaciclib plus fulvestrant was the most cost-effectiveness treatment option. One-way sensitivity analysis showed that the proportion of subsequent treatment, utility values of progression-free survival (PFS), cost of best supportive care had a significant impact on ICER. Probabilistic sensitivity analysis demonstrated that abemaciclib plus fulvestrant achieved an overwhelming superiority with a 99.82% probability to be the most cost-effective strategy in China at the current price and willingness-to-pay threshold. Conclusions: From the perspective of Chinese healthcare system, abemaciclib plus fulvestrant represented the optimal regimen as the second-line treatment for HR+/HER2- advanced or metastatic breast cancer.
Keywords: Cost-Effectiveness, HR+/HER2- advanced or metastatic breast cancer, CDK4/6 inhibitors, Abemaciclib, Palbociclib, Ribociclib, fulvestrant
Received: 05 Dec 2024; Accepted: 25 Aug 2025.
Copyright: © 2025 Wang, Liu, Li and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jie Gao, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
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