Cost-utility analysis of sacituzumab govitecan versus chemotherapy for the treatment of metastatic triple-negative breast cancer in Singapore

To assess the cost-effectiveness of sacituzumab govitecan for treating relapsed or refractory metastatic triple-negative breast cancer (TNBC) in Singapore.
A three-state partitioned survival model was developed to evaluate the cost-effectiveness of sacituzumab govitecan from a healthcare system perspective over 5 years. Clinical inputs were obtained from the ASCENT trial. Health state utilities were retrieved from the literature and direct costs were sourced from public healthcare institutions in Singapore. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties and assumptions on cost-effectiveness results.
Compared with single-agent chemotherapy, sacituzumab govitecan was associated with a base-case incremental cost-effectiveness ratio (ICER) of S$328,000 (US$237,816) per quality-adjusted life year (QALY) gained. One-way sensitivity analyses showed that the ICER was most sensitive to the cost of sacituzumab govitecan and progression-free utility values. Regardless of variation in these parameters, the ICER remained high, and a substantial price reduction was required to reduce the ICER.
At its current price, sacituzumab govitecan does not represent a cost-effective treatment for relapsed or refractory metastatic TNBC in Singapore. Our findings will be useful to inform funding decisions alongside other factors including clinical effectiveness, safety, and budget impact considerations.

本研究旨在评估戈沙妥珠单抗（sacituzumab govitecan）用于治疗新加坡地区复发或难治性转移性三阴性乳腺癌（TNBC）的成本效益。
研究构建了三分区生存模型，从医疗系统视角出发，对戈沙妥珠单抗开展了为期5年的成本效益评价。临床参数取自ASCENT临床试验；健康状态效用值来源于公开文献，直接医疗成本则取自新加坡公立医疗机构。此外，本研究开展了敏感性分析与场景分析，以探究不确定性及假设条件对成本效益分析结果的影响。
与单药化疗方案相比，戈沙妥珠单抗的基础案例增量成本效果比（ICER）为每获得1个质量调整生命年（QALY）328,000新加坡元（折合237,816美元）。单因素敏感性分析结果显示，增量成本效果比对戈沙妥珠单抗的用药成本及无进展状态效用值最为敏感。即便上述参数存在波动，增量成本效果比仍处于较高水平，需大幅降价方可使该比值降至可接受区间。
以当前售价而言，戈沙妥珠单抗在新加坡地区并不适合作为复发或难治性转移性三阴性乳腺癌的成本效益优先治疗选择。本研究结果可为医保资助决策提供参考依据，同时需结合临床有效性、安全性及预算影响等其他因素综合考量。