Table 1.
Overview of all model parameters.
| Model inputs | Value | Distribution | Low | High | Source |
|---|---|---|---|---|---|
| HR PFS of ribociclib | 0.59 | CONSTANT | / | / | (12) |
| HR PFS of abemaciclib | 0.46 | CONSTANT | / | / | (14) |
| HR OS of ribociclib | 0.72 | CONSTANT | / | / | (13) |
| HR OS of abemaciclib | 0.76 | CONSTANT | / | / | (15) |
| Direct costs per cycle | |||||
| Palbociclib | $11,938 | CONSTANT | $9,550 | $11,938 | Medicare Part D |
| Ribociclib | $13,110 | CONSTANT | $10,488 | $13,110 | Medicare Part D |
| Abemaciclib | $11,815 | CONSTANT | $9,452 | $11,815 | Medicare Part D |
| Fulvestrant | $1,808 | CONSTANT | $1,446 | $1,808 | Medicare Part B |
| Medical follow-up | $2,959 | GAMMA | $2,367 | $3,551 | (24) |
| Drug administration | $702 | GAMMA | $561 | $842 | (27) |
| After progression | $6,549 | GAMMA | $5,240 | $7,859 | (24) |
| Subsequent treatment | $9,061 | GAMMA | $7,248 | $10,873 | (24) |
| End of life care | $2,601 | GAMMA | $2,081 | $3,121 | (24) |
| Costs of MAEs per event | |||||
| Neutropenia | $16,256 | GAMMA | $14,871 | $17,642 | (28) |
| Leucopenia* | $16,256 | GAMMA | $14,871 | $17,642 | (28) |
| Diarrhea | $11,545 | GAMMA | $9,170 | $13,920 | (28) |
| Anemia | $14,532 | GAMMA | $13,262 | $15,804 | (28) |
| Infections | $14,595 | GAMMA | $11,248 | $18,425 | (28) |
| Hepatobiliary toxicity | $7,516 | GAMMA | $6,013 | $9,019 | (27) |
| Proportion of patients received subsequent treatment | |||||
| Palbociclib | 71% | BETA | 64% | 96% | (11) |
| Ribociclib | 61% | BETA | 57% | 85% | (13) |
| Abemaciclib | 63% | BETA | 49% | 73% | (15) |
| Fulvestrant | 80% | BETA | 50% | 76% | (11) |
| Risk of AEs in palbociclib | |||||
| Neutropenia | 0.696 | BETA | 0.557 | 0.835 | (11) |
| Leucopenia | 0.383 | BETA | 0.306 | 0.460 | (11) |
| Infections | 0.052 | BETA | 0.042 | 0.062 | (11) |
| Anemia | 0.043 | BETA | 0.034 | 0.052 | (11) |
| Risk of AEs in ribociclib | |||||
| Neutropenia | 0.571 | BETA | 0.457 | 0.685 | (13) |
| Leucopenia | 0.155 | BETA | 0.124 | 0.186 | (13) |
| Hepatobiliary toxicity | 0.137 | BETA | 0.110 | 0.164 | (13) |
| Infections | 0.077 | BETA | 0.062 | 0.092 | (13) |
| Anemia | 0.039 | BETA | 0.031 | 0.047 | (13) |
| Risk of AEs in abemaciclib | |||||
| Neutropenia | 0.297 | BETA | 0.238 | 0.356 | (15) |
| Leucopenia | 0.111 | BETA | 0.089 | 0.133 | (15) |
| Diarrhea | 0.145 | BETA | 0.116 | 0.174 | (15) |
| Anemia | 0.090 | BETA | 0.072 | 0.108 | (15) |
| Risk of AEs in fulvestrant | |||||
| Neutropenia | 0.006 | BETA | 0.005 | 0.007 | (11) |
| Leucopenia | 0.035 | BETA | 0.028 | 0.042 | (11) |
| Anemia | 0.023 | BETA | 0.018 | 0.028 | (11) |
| QoL utility (per year) | |||||
| PF | 0.837 | BETA | 0.753 | 0.921 | (29) |
| PP | 0.443 | BETA | 0.399 | 0.487 | (30) |
| Disutilities of AEs (per year) | |||||
| Neutropenia | −0.2466 | CONSTANT | −0.2713 | −0.2220 | (31) |
| Leucopenia* | −0.2466 | CONSTANT | −0.2713 | −0.2220 | (31) |
| Diarrhea | −0.1198 | CONSTANT | −0.1318 | −0.1078 | (31) |
| Anemia | −0.1914 | CONSTANT | −0.2105 | −0.1722 | (31) |
| Infections | −0.2303 | CONSTANT | −0.2534 | −0.2073 | (31) |
| Hepatobiliary toxicity | −0.3080 | CONSTANT | −0.3696 | −0.2464 | (32) |
| AEs duration (days) | |||||
| Neutropenia | 2 | CONSTANT | / | / | (33) |
| Leucopenia* | 2 | CONSTANT | / | / | (33) |
| Diarrhea | 2 | Normal | / | / | (34) |
| Anemia | 21 | Normal | / | / | (33) |
| Infections | 4.2 | Normal | / | / | (35) |
| Hepatobiliary toxicity | 4.3 | Normal | / | / | (35) |
| Duration of subsequent treatment (cycles) | 4.66 | Normal | 3.73 | 5.59 | (36) |
| Discount rate | 3% | CONSTANT | 0% | 5% | (29) |
PFS, progression-free survival; OS, overall survival; HR, hazard ratio; MAE, main adverse event.
*
The parameters of leucopenia were assumed to be the same as those of neutropenia.