{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T04:06:39Z","timestamp":1769227599044,"version":"3.49.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study was to compare the cost-effectiveness of various CDK4\/6 inhibitors plus fulvestrant with fulvestrant monotherapy in the second-line treatment for patients with HR+\/HER2\u2212 advanced or metastatic breast cancer from the Chinese healthcare system perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A partitioned survival model was established to investigate the total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over a 10-year lifetime horizon. Clinical data was derived from the MONARCH 2 trial, PALOMA 3 trial and MONALEESA 3 trial; direct medical costs and utilities were acquired from local charges and published literature. Scenario, one-way and probabilistic sensitivity analyses were performed to test the robustness of the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the base-case analysis, abemaciclib plus fulvestrant, palbociclib plus fulvestrant, ribociclib plus fulvestrant resulted in ICERs of $3,636.51\/QALY, $1,256.32\/QALY, and $39,654.78\/QALY, respectively, compared with fulvestrant monotherapy. In the pairwise comparison between three CDK4\/6 inhibitors, abemaciclib plus fulvestrant was the most cost-effectiveness treatment option. One-way sensitivity analysis showed that the proportion of subsequent treatment, utility values of progression-free survival (PFS), cost of best supportive care had a significant impact on ICER. Probabilistic sensitivity analysis demonstrated that abemaciclib plus fulvestrant achieved an overwhelming superiority with a 99.82% probability to be the most cost-effective strategy in China at the current price and willingness-to-pay threshold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>From the perspective of Chinese healthcare system, abemaciclib plus fulvestrant represented the optimal regimen as the second-line treatment for HR+\/HER2\u2212 advanced or metastatic breast cancer.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2025.1540088","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:21:45Z","timestamp":1757312505000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness analysis of CDK4\/6 inhibitors in the second-line treatment for HR+\/HER2\u2212 advanced or metastatic breast cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Kaixuan","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shixian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunping","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6053","DOI":"10.3390\/curroncol29090476","article-title":"Cost-effectiveness of pyrotinib plus capecitabine versus lapatinib plus capecitabine for the treatment of HER2-positive metastatic breast cancer in China: a scenario analysis of health insurance coverage","volume":"29","author":"Bao","year":"2022","journal-title":"Curr. 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