Introduction
The Kisqali (ribociclib) service impact model demonstrates the impact of introducing ribociclib within a service on appointment numbers and costs for patients with early breast cancer treatments for patients with the HR+/HER2− subtype.
The model allows the user to view and select the population by cancer stage and region/organisation. The user can make changes to the assumed baseline for each characteristic, and the whole population.
This document’s intended audience is professionals involved in policy and decision-making on budgets. It is not intended for healthcare professionals whose sole role is to prescribe medicines for the treatment of early breast cancer.
Instructions
- User input cells. The reset button clears these cells and restores default values
- Fixed values.
- Drop down list.
Abbreviations
List of abbreviations used throughout the model:
Al Aromatase inhibitor ALT Alanine aminotransferases AST Aspartate aminotransferases BC Breast Cancer BNF British National Formulary ET Endocrine therapy
HCRU Healthcare resource utilisation HER2 Human epidermal growth factor receptor 2 HR Hormone receptor ICB Integrated Care Boards PI Prescribing Information
QT The time between the start of the QRS complex (combination of the Q wave, R wave, and S wave) and the end of the T wave. QTcF corrected QT interval by Fridericia SmPC Summary of Product Characteristics
Model assumptions
- Annual treatment costs are calculated using the SmPC and BNF documents. The calculations use drug list prices. Further details of the calculations can be seen in the "Treatment costs" section.
- Throughout the model, certain medicines are listed as their respective drug class and others are listed as individual drugs. The aromatase inhibitor (Al) cost is the average cost of anastrozole and letrozole. The luteinising hormone releasing hormone (LHRH) agonist cost is the average cost of goserelin and leuprorelin. This is done for simplicity and due to a similar cost and clinical use of individual drugs in the same class.
- The population is taken as the whole of the HR+/HER2- cohort, and whichever of stage II and III is selected by the user. Due to a lack of specific data, patients with T2NO who do not fulfil the criteria G3 or G2 with Ki-67 > 20% have not been excluded from the population figure, but this group should be excluded to align with the NATALEE eligible population.1
- The treatment distribution data is auto-populated with placeholder data that assumes an equal split of all applicable treatments in baseline and year 1 of the scenario. This means that baseline takes an equal split of all treatments except those containing ribociclib, as it is not yet available and requires user input to investigate the impact of changes in prescribing.
- Incidence data is available at a sub-ICB level. This is then extrapolated using population data to achieve values for Trust and ICS footprints.
- Where possible, we assume that all test and monitoring appointments coincide to achieve the optimal total number of appointments.
- For treatments involving CDK4/6 inhibitors, after a patient has finished the maximum length of treatment, as defined in the SmPC, patients are assumed to continue on their regimen excluding the CDK4/6 inhibitor add-on (i.e. a patient who has completed 3 years of treatment with ribociclib + Al + LHRH agonist continues to be treated with LHRH agonist + Al for the remainder of the time horizon).
- Monitoring frequencies are taken from information noted in NICE TA 810. It is assumed that the monitoring frequency for ribociclib can be taken to be the same as that of abemaciclib, both being CDK 4/6is.