Objective  To evaluate the cost-effectiveness of abemaciclib plus fulvestrant as second-line treatment for hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)- negative advanced breast cancer.

Methods  From the perspective of Chinese healthcare system, based on the data from the MONARCH 2 clinical trial, a dynamic Markov model was constructed to simulate the lifetime direct medical costs and quality-adjusted life years (QALYs) of patients. Incremental cost-effectiveness ratio (ICER) was used to evaluate the economics of abemaciclib plus fulvestrant and fulvestrant monotherapy for HR+/HER2- advanced breast cancer, and the sensitivity of the results was analyzed.

Results  Compared with fulvestrant monotherapy, abemaciclib plus fulvestrant group could bring more health benefits (5.31 QALYs vs. 4.49 QALYs), but the total cost was higher (591 689 yuan vs. 462 183 yuan), and the ICER was 157 934.15 yuan/QALY, which was lower than the threshold of willingness to pay (WTP) based on 3 times per capita gross domestic product (GDP) in 2021. The results of one-way sensitivity analysis showed that parameters such as the health utility value in the progression free survival (PFS) state, the probability of targeted drug therapy in the fulvestrant group, and the probability of chemotherapy in the fulvestrant group had great impacts on the ICER value. The results of probabilistic sensitivity analysis showed that the probability of economic efficiency of abemaciclib plus fulvestrant gradually increased and eventually approached 100% when the WTP threshold exceeded 243 000 yuan per QALY. Abemaciclib plus fulvestrant scheme was a prefered therapeutic schedule.

Conclusion  Abemaciclib plus fulvestrant is more economical as a second-line therapy for HR﹢/HER2﹣ advanced breast cancer compared with fulvestrant monotherapy.

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