Fuzuloparib with or without apatinib in patients with HER2-negative metastatic breast cancer with germline BRCA1/2 mutations: a cost-utility analysis.

Fuzuloparib, a novel PARP inhibitor, has demonstrated efficacy in patients with HER2-negative metastatic breast cancer (MBC) harboring germline BRCA1/2 mutations. The addition of apatinib, an anti-angiogenic agent, enhances treatment outcomes. However, the economic value of these strategies remains unclear. To evaluate the cost-utility of fuzuloparib with or without apatinib compared with standard chemotherapy in patients with HER2-negative metastatic breast cancer with germline BRCA mutations from the Chinese healthcare system perspective. A partitioned survival model was developed over a 10-year time horizon. Clinical inputs were derived from the phase III FABULOUS trial. Survival data were reconstructed and extrapolated using parametric models. Costs and utilities were obtained from published literature and Yaozh databases. Outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs). A willingness-to-pay (WTP) threshold of ¥199,330/QALY was applied. Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. In the base-case analysis, total costs were ¥266,989.27 for fuzuloparib plus apatinib (FA), ¥230,151.42 for fuzuloparib monotherapy (FM), and ¥188,774.18 for standard chemotherapy (SC). Corresponding QALYs were 1.5669, 1.4128, and 1.1477, respectively. Compared with SC, the ICURs were ¥186,581.80 per QALY for FA and ¥156,081.63 per QALY for FM, both lower than the WTP threshold. Compared with FM, the ICUR was ¥239,051.59 per QALY for FA. Sensitivity analyses confirmed that the probability of the FA, FM and SC being cost-effective were 29.15%, 42.72%, and 28.13% at the WTP threshold. From the perspective of the Chinese healthcare system, both fuzuloparib plus apatinib and fuzuloparib monotherapy is cost-effective compared with standard chemotherapy at current WTP threshold. However, FA was not cost-effective relative to FM at the current Chinese WTP threshold.