OBJECTIVES : To estimate the cost-effectiveness of palbociclib with letrozole (Palb) vs. docetaxel with epirubicin (Chemo) as first-line therapy for patients with HR+/HER2- advanced or metastatic breast cancer in China.

METHODS : A validated 3-state Markov model with monthly cycle was constructed to estimate the lifetime incremental cost-effectiveness ratio (ICER). The time spent in 2 survival states (progression-free survival and post-progression survival) in Palb group was estimated by parametric extrapolations to survival data observed in the real-world study FLATIRON and the time in Chemo group was estimate by a net-work meta study. Utilities were calculated from EQ-5D of patients in the clinical trial PALOMA 2 and published literatures. The costs obtained from Chinese real world data including drugs, administration, adverse events management, follow-up and therapeutic costs. Costs and outcomes were both discounted at 5%. One way sensitivity analysis and probabilistic sensitivity analysis were conducted to demonstrate the robustness of the results.

RESULTS : Palbociclib with letrozole provided 3.07 QALYs at a cost of CNY 665,213, whereas docetaxel with epirubicin provided 1.63 QALYs at a cost of CNY 466,149. The ICER was CNY 138,534 per QALY, which was between 1~2 times GDP per capita, far below the local threshold of 3 times GDP per capita in 2019 (CNY 212,676). One-way sensitivity analysis showed the results were generally robust. Probabilistic sensitivity analysis showed that palbociclib with letrozole was more cost-effective in more than 92% simulations at the local threshold of 3 times GDP per capita in 2019.

CONCLUSIONS : Compared to docetaxel with epirubicin, palbociclib with letrozole is more cost-effective as first-line therapy for patients with HR+/HER2- advanced or metastatic breast cancer in China.