Objective. To conduct a pharmacoeconomic analysis of capivasertib plus fulvestrant compared with alpelisib plus fulvestrant for the treatment of locally advanced or metastatic HR-positive, HER2-negative breast cancer in the Russian Federation. Material and methods. The cost analysis considered adult postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer harboring a PIK3CA mutation after relapse or progression on a treatment regimen including an aromatase inhibitor or after its completion. The comparator was alpelisib plus fulvestrant. As the indirect comparison showed no statistically significant differences in progression-free survival between the alternatives, a cost-minimization approach was used. The time horizon was 10 years. The budget impact analysis considered adult postmenopausal women with metastatic HR-positive, HER2-negative breast cancer with alterations in the AKT pathway (PIK3CA/AKT1/PTEN) after relapse or progression on endocrine therapy or after its completion, for whom chemotherapy was not indicated. Scenario 1 assumed switching patients with a PIK3CA mutation to alpelisib plus fulvestrant, whereas scenario 2 assumed treatment of the entire target population with capivasertib plus fulvestrant. The time horizon was 2 years. Results. The use of capivasertib plus fulvestrant was associated with a reduction in discounted costs of RUB 302.773 (15.0%) per patient compared with alpelisib plus fulvestrant. Treating the entire target population with capivasertib plus fulvestrant resulted in savings of RUB 114.12 million (11.1%) over 2 years compared with the scenario in which patients with a PIK3CA mutation received alpelisib plus fulvestrant, while the remaining patients received treatment according to current clinical practice. Conclusions. The use of capivasertib plus fulvestrant can reduce healthcare costs and expand the use of targeted therapy compared with alpelisib plus fulvestrant.
Avxentyev et al. (Thu,) studied this question.