From budget constraints to value-based payment: an incremental cost-effectiveness analysis of sacituzumab tirumotecan for advanced triple-negative breast cancer in China

BACKGROUND: Robust pharmacoeconomic evidence regarding the long-term affordability of sacituzumab tirumotecan (sac-TMT) in treatment of metastatic triple-negative breast cancer (TNBC) remains lacking. We evaluated the cost-effectiveness of sac-TMT versus chemotherapy for previously treated metastatic TNBC from the perspective of Chinese payers. RESEARCH DESIGN AND METHODS: A partitioned survival model was developed using clinical efficacy and safety data from the OptiTROP-Breast01 trial. Key inputs included survival probability, incidence of adverse events, direct medical costs, and utility values. Total costs, quality adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) were calculated as main outputs. Sensitivity analyses tested parameter uncertainty. RESULTS: Sac-TMT provided an incremental survival benefit of 0.40 QALY compared to chemotherapy but incurred extra costs of $33,029.53. The corresponding ICER was $82,573.83/QALY, substantially exceeding the willingness-to-pay (WTP) thresholds of $40,343.68/QALY. Drivers of unaffordability were utility value of progressive disease, price of sac-TMT, and body weight. Probabilistic sensitivity analysis showed that the probability of sac-TMT being cost-effective was 0.68%, and price simulation manifested that a 77.5% price reduction for sac-TMT could make it economical. CONCLUSION: Sac-TMT is not cost-effective for metastatic TNBC compared to chemotherapy at current pricing. Significant price reductions are essential to justify its economic value in resource-constrained settings.