International journal of women's health · 2026
Cost-Effectiveness of Culmerciclib Plus Fulvestrant for Previously Treated HR-Positive/HER2-Negative Advanced Breast Cancer in China: An Integrated GBD 2023 Analysis.
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Xuan Feng, Ding Mengjuan, Qiu Zhaoqi, Wang Liejiong, Xu Haiyan
Аннотация
BACKGROUND: Breast cancer (BC) imposes a substantial and evolving health and economic burden in China. We integrated population-level disease burden with treatment-specific economic evaluation to assess the cost-effectiveness of culmerciclib plus fulvestrant for previously treated hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC).
METHODS: Using Global Burden of Disease Study 2023 data, we assessed BC incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and temporal trends in China. GBD estimates provided population-level context and were not direct inputs into the economic model. We then conducted a lifetime cost-effectiveness analysis from the Chinese healthcare perspective, comparing culmerciclib plus fulvestrant with placebo plus fulvestrant for previously treated HR+/HER2- ABC based on randomized Phase III trial efficacy. Outcomes included costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was $26,896/QALY, equivalent to twice China's per-capita gross domestic product.
RESULTS: In 2023, BC caused 342,725 incident cases, 3,496,338 prevalent cases, 76,589 deaths, and 2,458,481 DALYs in China. From 1990 to 2023, the age-standardized rates (ASRs) of incidence and prevalence increased, whereas the ASRs of mortality and DALY decreased. All four ASRs rose during 2020-2023. In the base-case analysis, culmerciclib plus fulvestrant provided an additional 0.90 QALYs at an incremental cost of $34,150.43 compared with placebo plus fulvestrant, resulting in an ICER of $37,886.61/QALY. At the prespecified WTP threshold, the probability of culmerciclib plus fulvestrant being cost-effective was 2.7%. Culmerciclib price was the main uncertainty driver. A 25% reduction in the price of culmerciclib lowered the ICER to $26,677.03/QALY.
CONCLUSIONS: Against the background of a substantial and evolving BC burden in China, culmerciclib plus fulvestrant provides additional health benefits but is unlikely to be cost-effective compared with placebo plus fulvestrant for previously treated HR+/HER2- ABC at its current price. Integrating population-level disease burden with treatment-specific economic evidence provides complementary information for healthcare resource allocation.
METHODS: Using Global Burden of Disease Study 2023 data, we assessed BC incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and temporal trends in China. GBD estimates provided population-level context and were not direct inputs into the economic model. We then conducted a lifetime cost-effectiveness analysis from the Chinese healthcare perspective, comparing culmerciclib plus fulvestrant with placebo plus fulvestrant for previously treated HR+/HER2- ABC based on randomized Phase III trial efficacy. Outcomes included costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was $26,896/QALY, equivalent to twice China's per-capita gross domestic product.
RESULTS: In 2023, BC caused 342,725 incident cases, 3,496,338 prevalent cases, 76,589 deaths, and 2,458,481 DALYs in China. From 1990 to 2023, the age-standardized rates (ASRs) of incidence and prevalence increased, whereas the ASRs of mortality and DALY decreased. All four ASRs rose during 2020-2023. In the base-case analysis, culmerciclib plus fulvestrant provided an additional 0.90 QALYs at an incremental cost of $34,150.43 compared with placebo plus fulvestrant, resulting in an ICER of $37,886.61/QALY. At the prespecified WTP threshold, the probability of culmerciclib plus fulvestrant being cost-effective was 2.7%. Culmerciclib price was the main uncertainty driver. A 25% reduction in the price of culmerciclib lowered the ICER to $26,677.03/QALY.
CONCLUSIONS: Against the background of a substantial and evolving BC burden in China, culmerciclib plus fulvestrant provides additional health benefits but is unlikely to be cost-effective compared with placebo plus fulvestrant for previously treated HR+/HER2- ABC at its current price. Integrating population-level disease burden with treatment-specific economic evidence provides complementary information for healthcare resource allocation.