Cost–utility and price threshold analysis of sacituzumab tirumotecan versus single-agent chemotherapy for previously treated metastatic triple-negative breast cancer in China

Background: Sacituzumab tirumotecan (Sac-TMT) has demonstrated survival benefits over chemotherapy in patients with previously treated metastatic triple-negative breast cancer (mTNBC). However, its economic value under different payment contexts in China remains uncertain. Methods: A state-transition (Markov) model was used to estimate lifetime costs and quality-adjusted life-years (QALYs) for Sac-TMT versus single-agent chemotherapy in second-line and later-line mTNBC. Clinical efficacy was derived from a phase III randomized trial, with survival extrapolated using parametric models. Cost-utility and price threshold analyses were conducted using willingness-to-pay (WTP) thresholds defined as three times the per-capita gross domestic product (GDP) at the national level and in economically underdeveloped regions. Scenarios incorporating patient assistance programs were also evaluated. Results: Sac-TMT increased QALYs but incurred substantially higher costs, resulting in incremental cost-effectiveness ratios exceeding both national and regional WTP thresholds at the current list price. To achieve cost-effectiveness, the price of Sac-TMT would need to be reduced to 48.3% of the current list price under the national WTP threshold and to 34.9% under the regional threshold. Although patient assistance programs increased the acceptable price range, Sac-TMT remained unlikely to be cost-effective at the list price. The reimbursed price following the 2025 national health insurance negotiation was markedly below these thresholds, suggesting improved economic value under current reimbursement conditions. Conclusion: Sac-TMT is unlikely to be cost-effective at its current list price for previously treated mTNBC in China. Substantial price reductions and reimbursement strategies may improve its economic value, particularly in economically underdeveloped regions

Breast cancer · China · List price · Metastatic breast cancer · Payment · Reimbursement · Willingness to pay · Advanced Breast Cancer Therapies · Breast Cancer Treatment Studies · Cancer Treatment and Pharmacology

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