OBJECTIVES: This study aimed to provide a comprehensive review on cost-effectiveness of palbociclib in breast cancer patients and the HCRU associated with the treatment.

METHODS: A literature search was performed in publicly available databases using relevant search strings till November 2023. A supplementary open search was also run-on Google to identify any missed relevant articles. The studies were screened by two reviewers. The quality of reporting and the risk of bias of the included economic evaluations were assessed qualitatively using the CHEERS and the ECOBIAS checklist, respectively.

RESULTS: Seventeen studies reporting economic evaluations of palbociclib were included. The time-horizon ranged from 6-40 years, while some studies used full-life cycle to simulate costs and health outputs of patients. Majority of the studies were of national healthcare system perspective.

The life-years gained ranged from 3.73 to 5.96 years, whereas the QALYs gained ranged from 1.14 to 4.51. Six studies reported that ribociclib was dominant over palbociclib in terms of cost-effectiveness. One study demonstrated that neither palbociclib nor ribociclib was cost-effective and one study demonstrated a cost-saving profile for palbociclib as compared to ribociclib or abemaciclib. Eight studies reported that palbociclib was not cost-effective as compared to endocrine therapy. One study reported that cost-effectiveness of everolimus and palbociclib are equivalent. Drug cost was the key contributor to total costs in majority of studies.

One study which assessed the HCRU reported that comparisons between the reweighted palbociclib and ribociclib cohorts yielded no observable differences for the number of in-patient admissions [incidence rate ratios (IRR): 1.13], in-patient days (IRR: 0.86), days with emergency-room services (IRR: 1.56), or days with out-patient services (IRR: 1.01).

CONCLUSIONS: These findings suggest that although there were no observable differences seen between palbociclib and ribociclib regarding HCRU, ribociclib continues to be cost-effective as compared to palbociclib, with drug cost being the major contributor.