The NICE appraisal committee wanted to understand if the model structure used for ribociclib was valid, and what the main sources of uncertainty in the model were. These issues arose because the economic models for ribociclib and palbociclib in the same indication reported different cost-effectiveness results, whereas the clinical trials reported similar findings.
The economic model for ribociclib was a patient level simulation which assumed that after progression on ribociclib (or comparator), patients who were still alive followed the progression-free survival and overall survival of the subsequent treatment.
Furthermore, the ribociclib model gave counterintuitive results: without a patient access scheme for ribociclib, increasing the survival gains resulted in ribociclib becoming less cost-effective.
The Decision Support Unit were asked to review the evidence supporting the model assumptions, inputs and structure, and explore alternatives which could be used.
Ribociclib in combination with an aromatose inhibitor for previously untreated advanced or metastatic hormone receptor-positive, her2-negative breast cancer: a review of the model structure, inputs and assumptions. (PDF, 1.2MB) (August 2017)