Cost-effectiveness of sacituzumab tirumotecan versus chemotherapy for patients with metastatic triple-negative breast cancer in China.

PURPOSE: Sacituzumab tirumotecan (sac-TMT), a trop-2-targeted antibody-drug conjugate, has demonstrated significant clinical benefit in the OptiTROP-Breast01 trial for patients with advanced or metastatic triple-negative breast cancer (TNBC). This study evaluated the cost-effectiveness of sac-TMT compared with chemotherapy from the perspective of the Chinese healthcare system. METHODS: A partitioned survival model incorporating multiple survival extrapolation approaches was developed to estimate long-term clinical and economic outcomes. Survival data were reconstructed from the OptiTROP-Breast01 trial, while cost and utility inputs were derived from publicly databases and literature. Outcomes included life-years, quality-adjusted life-years (QALYs), total costs, and key economic endpoints: incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), incremental net monetary benefit (INMB), and expected value of perfect information (EVPI). Sensitivity, scenario, and subgroup analyses were conducted to assess uncertainty. RESULTS: In the base-case analysis, sac-TMT yielded an additional 0.32 QALYs and 0.35 life-years compared with chemotherapy, with an incremental cost of $31815.17, resulting in an ICER of $98796.02 per QALY, exceeding the $40763.34 threshold in China. One-way sensitivity analysis identified the dose intensity, utility for PFS, patient weight, and price of sac-TMT as key drivers of ICER. Scenario analysis showed that reducing the drug price to 20 % of the current level would lower the ICER to $13319.46/QALY, with a 99.82 % probability of cost-effectiveness. EVPI was estimated at $33.69 per person. CONCLUSION: While sac-TMT offers survival benefits in metastatic TNBC, it is unlikely to be cost-effective at current pricing. Substantial price reductions and optimized use may improve its economic value and support reimbursement.