ArticlePharmacoEconomics - open2026
Cost-Effectiveness Analysis of Ribociclib plus an Aromatase Inhibitor (AI) Versus AI Alone in the Adjuvant Treatment of Stage II and III Pre- and Postmenopausal Women with HR+/HER2- Early Breast Cancer (EBC): A Canadian Payer Perspective.
Article in PharmacoEconomics - open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have transformed the treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) breast cancer. Ribociclib plus an aromatase inhibitor (AI) was approved in Canada as adjuvant treatment for high-risk stage II-III early breast cancer (EBC) based on the phase 3 NATALEE trial, demonstrating improved invasive disease-free survival (iDFS) versus AI treatment alone. This study evaluated the cost-effectiveness of ribociclib plus AI versus AI alone and tamoxifen from a Canadian public payer perspective.
methodsA non-homogeneous, semi-Markov cohort model with six health states (iDFS, second primary malignancy, non-metastatic recurrence, remission, distant recurrence [DR], and death) was developed, using Ontario-based costs (Canadian dollars) and a lifetime horizon. Transition probabilities from iDFS were derived from NATALEE trial data; other transitions were informed by published sources. DR was stratified by endocrine therapy (ET) sensitivity based on recurrence timing (≤ 12 months post-ET: resistant; > 12 months: sensitive), with outcomes and costs informed by prior health technology assessment evidence in metastatic disease. Results were reported as incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained.
resultsRibociclib plus AI yielded a probabilistic ICER of $45,097/QALY versus AI alone; tamoxifen was dominated by AI alone. Sensitivity analyses showed results were most sensitive to iDFS hazard rates and ribociclib drug costs. In the probabilistic analysis, ribociclib was preferred in 58.5% of simulations at a $50,000 willingness-to-pay threshold.
conclusionRibociclib plus AI is cost-effective for HR+/HER2- EBC with an ICER of $45,097, below the $50,000 willingness-to-pay threshold versus AI or tamoxifen alone.
Identifiers
42825982What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.