A cost-effectiveness analysis of letrozole with or without palbociclib as first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer; a health economic analysis of the SAKK Network Outcomes Research

K. Matter-Walstra 1,2, T. Ruhstaller 2,3, D. Klingbiel 2, M. Schwenkglenks 1, K. J. Dedes 2,4

1 Institute of Pharmaceutical Medicine (ECPM), University Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland

2 Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, CH-3008 Bern, Switzerland

3 Breast Centre, Kantonsspital St. Gallen, Rorschacherstrasse 95 9007 St.Gallen, Switzerland

4 University Hospital Zürich, Department of Gynaecology, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland

Corresponding author:

Klazien Matter-Walstra

Institute of Pharmaceutical Medicine/ECPM, University Basel

Klingelbergstrasse 61, CH-4056 Basel, Switzerland

Tel +41 61 267 19 45, Fax +41 61 267 19 48


Supplementary Material

Table 1. Unit costs.

Unit costs / Doses per day / Number of days per cycle
PAL /mg / CHF 3.58 / 125mg / 21
Letrozole/mg / CHF 7.3 / 2.5mg / 28
Surveillance and treatment for grade 1-2 neutropenia* / CHF 100
Surveillance and treatment for grade 3-5 neutropenia* / CHF 1000
Computer tomography° / CHF 633
Magnetic resonance imaging°* / CHF 735

° 50% of patients every 8 weeks, *price according to TARMED (http://www.tarmedsuisse.ch/)


Table 2. Input parameter values and distribution types for the sensitivity analyses.

Type / Base case value / 2.5% / 97.5%
Clinical data [5]
HR OS / Lognormal / 0.80 / 0.45 / 1.28
HR PFS / Lognormal / 0.48 / 0.32 / 0.70
Progression free survival LET (months) / Gamma / 10.26 / 4.15 / 20.32
Time from PFS to OS LET (months) / Gamma / 13.50 / 9.91 / 17.72
Reduced days on PAL when treatment interruption / Uniform / 17 / 15 / 20
% Patients with treatment interruption PAL / Triangular / 33% / 27% / 39%
% Patients NP Grade 1-2 LET / Triangular / 24% / 3.0% / 4.8%
% Patients NP Grade 3-5 LET / Triangular / 1% / 0.8% / 1.2%
% Patients NP Grade 1-2 PALLET / Triangular / 20% / 16.0% / 23.9%
% Patients NP Grade 3-5 PALLET / Triangular / 54% / 44.0% / 65.0%
Utilities [20]
Utility PFS LET / Beta / 0.86 / 0.83 / 0.88
De-/increase in utility PFS PALLET / Uniform / 0% / -24% / 23%
Decrease in utility progressive disease (LET and PALLET) / Beta / 0.00 / 0.14 / 0.37
Follow-up costs [8]
FU costs CHF (LET and PALLET) / Lognormal / 6139 / 2472 / 14650
De-/increase in FU Costs PALLET / Uniform / 0 / -24% / 23%

FU = follow up, HR = hazard ratio, LET = letrozole, NP = neutropenia, OS = overall survival, PAL = palbociclib, PFS = progression-free survival

Figure 1. Model structure.

LET = letrozole, M = Markov node, PAL = palbociclib