BACKGROUND: The EVER-132-002 trial demonstrated the significant efficacy and manageable safety of sacituzumab govitecan in hormone receptor-positive human epidermal growth factor receptor 2-negative (HR + HER2-) metastatic breast cancer. This study evaluated the cost-effectiveness of sacituzumab govitecan compared with chemotherapy from the Chinese healthcare system perspective. METHODS: A partitioned survival model at 21-day intervals over a 10-year time horizon was developed to evaluate the total cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay (WTP) threshold of 3 times gross domestic product per capita ( 8,042.49 per QALY). Clinical data were extracted from the EVER-132-002 trial
direct medical costs and utility values were obtained from public bid-winning databases, local charges or published literature. To determine the model's robustness, scenario, one-way, two-way and probabilistic sensitivity analyses were performed. RESULTS: Compared with chemotherapy, sacituzumab govitecan generated an additional cost of 1,273.72, with an additional QALY of 0.43, resulted in an ICER of 11,948.62 per QALY. Patient weight was the most influential parameter on base-case results, and variations in each parameter did not substantially alter the conclusion. Probabilistic sensitivity analysis demonstrated that the probability of sacituzumab govitecan to be cost-effective was zero at the WTP threshold of 8,042.49 per QALY. Scenario analysis indicated that sacituzumab govitecan would be cost-effective versus chemotherapy only if its cost was reduced by 83% ( 02.65 per unit) or more. CONCLUSIONS: Sacituzumab govitecan might not be cost-effective compared with chemotherapy in the treatment for HR + HER2- metastatic breast cancer in China.