In this real-world setting study, similar healthcare costs and healthcare resource utilization among patients treated with ribociclib and palbociclib were observed. However, fewer inpatient days were experienced by patients treated with ribociclib when compared with abemaciclib.
Women with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer may be effectively treated with CDK4/6 inhibitors, such as ribociclib, palbociclib, and abemaciclib. However, the burden of treatment on women with hormone receptor–positive, HER2-negative metastatic breast cancer from an economic standpoint has not been previously compared.
In this study, in the real-world setting the healthcare costs and healthcare resource utilization were compared among patients treated with CDK4/6 inhibitors.
Using a large US commercial claims database, data were aggregated between the first quarter of 2000 and the third quarter of 2018 for adult female patients with hormone receptor–positive, HER2-negative advanced or metastatic breast cancer who had received treatment with ribociclib, palbociclib, or abemaciclib as the first CDK4/6 inhibitor. While patients were receiving treatment with a CDK4/6 inhibitor, the healthcare cost and healthcare resource utilization were measured.
Measured from a payer’s perspective, total healthcare costs consisted of pharmacy costs and medical costs, which included visits that were inpatient, outpatient, and emergency departments. These were reported per-patient-per-month (PPPM).
Models were adjusted for age, line of therapy, menopausal status, metastatic sites, comorbidities, healthcare resource utilization, and healthcare cost components, and were individually compared between the ribociclib and palbociclib cohorts and between the ribociclib and abemaciclib cohorts.
A total of 4320 women were included in the study: 102 initiated ribociclib as first CDK4/6 inhibitor; 4118 received palbociclib; and 100 received abemaciclib.
In each cohort, the majority of patients were postmenopausal (ribociclib: 79%; palbociclib: 92%; abemaciclib: 92%) and received the index CDK4/6 inhibitor as either first-line (ribociclib: 40%; palbociclib: 31%; abemaciclib: 30%) or second-line therapy (ribociclib: 23%; palbociclib: 24%; abemaciclib: 22%). There was no statistical difference in healthcare resource utilization between the ribociclib and palbociclib cohorts, whereas the ribociclib cohort patients experienced fewer inpatient days compared with the abemaciclib cohort (adjusted incidence rate ratio, 0.25; 95% confidence interval [CI], 0.09-0.67). No statistical difference in total healthcare costs between the ribociclib and palbociclib cohorts was detected, although the ribociclib cohort had lower outpatient costs PPPM when compared with the palbociclib cohort (–$1339; 95% CI, –2344 to –209). There were statistically lower total healthcare costs for the ribociclib cohort when compared with the abemaciclib cohort (–$6519; 95% CI, –9959 to –2984). The inpatient costs, outpatient costs, and pharmacy costs (driven by CDK4/6 inhibitor costs) were all reported as significantly lower for the ribociclib cohort when compared with the abemaciclib cohort (inpatient: –$3398; 95% CI, –22,801 to –768; outpatient: –$3778; 95% CI, –6502 to –1659; pharmacy costs: –$1744; 95% CI, –2881 to –564).
There was similar healthcare resource utilization while receiving treatment when comparing ribociclib and palbociclib; however, after adjusting for baseline covariates, there were fewer inpatient days experienced by patients treated with ribociclib when compared with abemaciclib. Total healthcare costs for ribociclib and palbociclib were comparable, while total healthcare costs were higher in the abemaciclib cohort when compared with the ribociclib cohort.
Source: Balu S, Burne R, Gurerin A, et al. Comparison of healthcare resource utilization and costs in women with HR+/HER2- metastatic breast cancer treated with ribociclib vs palbociclib or abemaciclib. Presented at: 2020 San Antonio Breast Cancer Symposium, December 8-11, 2020. Abstract PS10-29.