{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:11:15Z","timestamp":1789603875401,"version":"build-2803163510"},"reference-count":46,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Incorporating adjuvant cyclin-dependent kinase (CDK) 4\/6 inhibitors abemaciclib and ribociclib along with endocrine therapy has been shown to improve invasive disease-free survival (iDFS) for hormone receptor\u2013positive (HR+) human epidermal receptor 2\u2013negative (HER2\u2013) early breast cancer (EBC). This study assesses the cost-effectiveness of this strategy, along with adjuvant aromatase inhibitors from an Indian perspective. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> A Markov chain model evaluated the cost-effectiveness of abemaciclib and ribociclib with letrozole compared with letrozole alone for HR+\/HER2\u2013 EBC from a payer perspective in India. Key measures included lifetime quality-adjusted life-years (QALY), life-years (LY), and total costs. This study explores two scenarios for effectiveness: a best-case (BC) scenario, where the benefit of CDK4\/6 inhibitors in improving iDFS lasts a lifetime, and a worst-case (WC) scenario, where benefits disappear after 5 years. Probabilistic sensitivity analyses (PSA) were used to account for simulation uncertainty. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> In the BC scenario, abemaciclib added 2.17 QALY and 4.96 LY, incurring \u20b92,317,957.7 ($27,756.65 in US dollars [USD]) in additional costs. However, the incremental cost-effectiveness ratio (ICER) for abemaciclib exceeded India's willingness-to-pay threshold in the BC and WC scenarios. In the BC scenario, ribociclib added 0.98 QALY and 2.58 LY with added costs of \u20b91,711,504.32 ($20,494.6 USD). The ICER for ribociclib also surpassed India's threshold in both scenarios. PSA showed that neither drug was cost-effective at the current market prices in either BC\/WC scenario. The cost of abemaciclib and ribociclib needs to be reduced by at least 78.61% and 87.19%, respectively, to be cost-effective in the BC scenario. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> The combination of adjuvant abemaciclib or ribociclib with letrozole is not cost-effective for HR+\/HER2\u2013 EBC in India in either the BC or WC scenario. <\/jats:p><\/jats:sec>","DOI":"10.1200\/go.23.00433","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T20:00:58Z","timestamp":1721332858000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":9,"title":["Cost-Effectiveness of Adjuvant Abemaciclib and Ribociclib in High-Risk Hormone Receptor\u2013Positive Early Breast Cancer: An Indian Perspective"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2939-5400","authenticated-orcid":true,"given":"Manraj Singh","family":"Sra","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Sasi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-8408","authenticated-orcid":true,"given":"Atul","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-4407","authenticated-orcid":true,"given":"Sameer","family":"Bakhshi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7296-6088","authenticated-orcid":true,"given":"Shuvadeep","family":"Ganguly","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.5306\/wjco.v13.i3.209"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-62618-3"},{"key":"b3","first-page":"S808","volume":"33","author":"Goetz M","year":"2022","journal-title":"Ann Oncol"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2114663"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2022.1450"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00694-5"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01994"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2305488"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30642-2"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-023-01245-y"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-019-05190-3"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-022-00731-2"},{"key":"b15","author":"Gupta N","journal-title":"JCO Glob Oncol"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-007-9679-4"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462313000160"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.693104"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2017.1400683"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07395-7"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2012.03.009"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2008.03.019"},{"key":"b26","doi-asserted-by":"publisher","DOI":"10.1177\/1756283X16644249"},{"key":"b28","doi-asserted-by":"publisher","DOI":"10.4048\/jbc.2015.18.2.160"},{"key":"b29","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200725050-00006"},{"key":"b30","author":"Gogia A","journal-title":"JCO Glob Oncol"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.791995"},{"key":"b32","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond MF","year":"2015","edition":"2"},{"key":"b33","doi-asserted-by":"publisher","DOI":"10.4103\/2230-8598.179754"},{"key":"b34","author":"Gupta N","journal-title":"JCO Glob Oncol"},{"key":"b35","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.202000076"},{"key":"b36","doi-asserted-by":"publisher","DOI":"10.4103\/0970-0218.91326"},{"key":"b37","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2024.100391"},{"key":"b38","author":"Sengar M","journal-title":"JCO Glob Oncol"},{"key":"b41","first-page":"147","volume":"15","author":"Jongbloed EM","year":"2023","journal-title":"Breast Cancer (Dove Med Press)"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00050-2017"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1413513"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1612645"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000816"},{"key":"b46","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02516-9"},{"key":"b47","doi-asserted-by":"publisher","DOI":"10.21037\/atm-21-5110"},{"key":"b48","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2022.02.006"},{"key":"b49","doi-asserted-by":"publisher","DOI":"10.1177\/17588359211000593"},{"key":"b50","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-023-03247-w"},{"key":"b51","doi-asserted-by":"publisher","DOI":"10.1158\/1538-7445.AM2023-4364"},{"key":"b52","first-page":"62","volume":"10","author":"Davie A","year":"2023","journal-title":"Glob Reg Health Technol Assess"},{"key":"b53","author":"Asghar US","journal-title":"JCO Precis Oncol"},{"key":"b54","doi-asserted-by":"publisher","DOI":"10.1038\/s41523-023-00574-7"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO.23.00433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T20:01:05Z","timestamp":1721332865000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO.23.00433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":46,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1200\/GO.23.00433"],"URL":"https:\/\/doi.org\/10.1200\/go.23.00433","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]},"assertion":[{"value":"2023-11-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-26","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2300433"}}