# Cost-Effectiveness of Sacituzumab Govitecan Versus Chemotherapy in Metastatic Triple—Negative Breast Cancer in Taiwan

## TL;DR

This study finds that the cancer drug sacituzumab govitecan is not cost-effective for treating advanced breast cancer in Taiwan at its current price.

## Contribution

The study evaluates the cost-effectiveness of sacituzumab govitecan in Taiwan, a new context not previously analyzed.

## Key findings

- Sacituzumab govitecan costs USD 121,836 per QALY gained, exceeding Taiwan’s WTP threshold of USD 102,120.
- A 50% price reduction would improve the likelihood of cost-effectiveness.
- Drug cost is the main factor affecting cost-effectiveness results.

## Abstract

Sacituzumab govitecan (SG) is a novel antibody–drug conjugate (ADC) targeting trophoblast cell surface antigen 2 (TROP2) expressing cancer cells. It delivers the topoisomerase I inhibitor SN-38 to induce DNA damage-mediated apoptosis. Sacituzumab is approved for patients with unresectable, locally advanced or metastatic triple-negative breast cancer who has received two or more prior systemic therapies, at least one of which was for metastatic disease. Based on the positive results from the Phase III ASCENT clinical trial, sacituzumab offers an alternative new mechanism treatment option for patients with metastatic triple-negative breast cancer who have failed initial chemotherapy and have a poor prognosis. However, previous cost-effectiveness analyses conducted in the United States and China concluded that sacituzumab is not cost-effective for mTNBC at its current price, within acceptable willingness-to-pay thresholds in each country. The results of this study suggest that SG needs to lower its current price or increase the WTP threshold value in order to achieve cost-effectiveness.

Objective: This study evaluated the cost-effectiveness of sacituzumab govitecan (SG) compared with single-agent chemotherapy of the physician’s choice (TPC) from the perspective of Taiwan’s National Health Insurance. Methods: A partitioned survival model was developed to assess outcomes in patients with metastatic triple-negative breast cancer (mTNBC). Clinical data were derived from the ASCENT trial, while direct medical costs were obtained from Taiwan’s National Health Insurance Administration (NHIA). Utility values were taken from published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to examine parameter uncertainty and test the robustness of the results. Results: In the base-case analysis, SG was associated with an incremental cost of USD 121,836 per QALY gained—exceeding Taiwan’s willingness-to-pay (WTP) threshold of USD 102,120. One-way sensitivity analyses indicated that SG drug cost was the primary driver of ICER variability. Probabilistic sensitivity analysis showed that reducing the price of SG by 50% increased the likelihood of cost-effectiveness. Conclusions: From the NHIA perspective, SG is not cost-effective for patients with advanced or metastatic TNBC at its current price. Substantial price reductions would be required for SG to become cost-effective under the WTP threshold of USD 102,120 per QALY.