Table 3Cost and Cost-Effectiveness

Component Description
Type of economic evaluation Cost-utility analysis

PSM

Target population Adults who had prior treatment with lenvatinib and/or sorafenib requiring second- or subsequent-line systemic treatment for advanced or metastatic RET fusion-positive DTC
Treatment Selpercatinib
Submitted price 40 mg: $66.50 per oral capsule ($3,990 per 60 capsule bottle)

80 mg: $133.00 per oral capsule ($7,980 per 60 capsule bottle)

Treatment cost $11,172 to $14,896 per 28 days
Comparator BSC (consisting of monitoring and palliative care)
Perspective Canadian publicly funded health care payer
Outcomes QALYs, LYs
Time horizon 10 years
Key data source Selpercatinib: Single-arm non-randomized LIBRETTO trial; naive comparison to BSC (informed by the SELECT trial)
Key limitations
  • The comparative efficacy of selpercatinib on PFS and OS is unknown due to the lack of head-to-head or comparative evidence for selpercatinib to BSC. The sponsor’s use of naive comparisons to inform the pharmacoeconomic model introduces unresolvable uncertainty into the economic evaluation.
  • The choice of a PSM to evaluate the cost-effectiveness of selpercatinib is inappropriate given the high level of uncertainty associated with the immature PFS and OS data from the LIBRETTO trial. The sponsor’s model assumes that patients are at risk of death only after disease progression, which is not supported by data from LIBRETTO.
  • Adjustment of drug acquisition costs by dose intensity observed in the LIBRETTO trial biased the ICER in favour of selpercatinib.
  • The model lacks transparency and is inefficiently programmed. Numerous errors were identified in the analysis, and CADTH could not ensure that the model results were accurately calculated.
CADTH reanalysis results
  • Due to the identified limitations regarding the lack of comparative clinical effectiveness, as well as issues with the submitted model (including poor modelling practices and structural limitations), the comparative clinical effectiveness, and, as a result, the cost-effectiveness, of selpercatinib relative to BSC is unknown.
  • CADTH conducted an exploratory analysis, which included adjusting for preprogression mortality and adopting appropriate estimates of drug acquisition costs.
  • In CADTH exploratory reanalyses, the ICER for selpercatinib is $402,705 per QALY ($405,245 per QALY, when including RET mutation testing) compared to BSC. Price reductions of at least 89% would be required for selpercatinib to be considered cost-effective at a willingness-to-pay threshold of $50,000 per QALY. The results of these reanalyses should be viewed only as exploratory given the previously mentioned limitations, and, given the extensive uncertainty associated with the comparative clinical effectiveness, a higher price reduction may be warranted.

BSC = best supportive care; DTC = differentiated thyroid carcinoma; ICER = incremental cost-effectiveness ratio; LY = life-years OS = overall survival; PFS = progression-free survival; PSM = partitioned survival model; QALY = quality-adjusted life-year; RET = rearranged during transfection.

From: Selpercatinib (Retevmo)

Cover of Selpercatinib (Retevmo)
Selpercatinib (Retevmo): CADTH Reimbursement Recommendation: Indication: Adult patients with rearranged during transfection (RET) fusion-positive differentiated thyroid carcinoma with advanced or metastatic disease (not amenable to surgery or radioactive iodine therapy) following prior treatment with sorafenib and/or lenvatinib [Internet].
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