Cost-effectiveness of inavolisib-based therapy in PIK3CA-mutated advanced breast cancer in the USA
In brief
Inavolisib plus palbociclib/fulvestrant costs $148k per QALY, meets US threshold
A decision-analytic model showed that adding inavolisib to palbociclib and fulvestrant yields about 1.4 quality-adjusted life-years at an incremental cost of $212 k, resulting in an incremental cost-utility ratio of $148 k per QALY-just under the $150 k willingness-to-pay benchmark. Probabilistic analysis gave a 55% chance of being cost-effective, suggesting it could be a valuable option but with modest certainty.
- Journal
- Breast (Edinburgh, Scotland) (Q1)
- Published
- 27 July 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Shixian Liu, Kaixuan Wang, Hao Chen, Ziming Wan, Lei Dou, Shunping Li
- PMID
- 42543051
- DOI
- 10.1016/j.breast.2026.104889
Why clinicians should know about it
- Picked for Health Policy (paper of the day, 3 August 2026).
Abstract
PURPOSE: Inavolisib plus palbociclib and fulvestrant has been approved for treating PIK3CA-mutated, hormone receptor-positive human epidermal growth factor receptor 2-negative (HR + HER2-), advanced breast cancer in the USA. This study evaluated the cost-effectiveness of inavolisib plus palbociclib and fulvestrant compared with palbociclib plus fulvestrant from the US payer perspective. METHODS: We developed a partitioned survival model at a 28-day cycle length over 15-year time horizons to predict total costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR) at willingness-to-pay (WTP) threshold of $150,000 per QALY. Survival data were extracted from the INAVO120 clinical trial, costs and utilities were obtained from the department of Veterans Affairs, published literature and quality-of-life studies using the EQ-5D-5L scale. Uncertainty was addressed via scenario, one-way and probabilistic sensitivity analyses. RESULTS: In the base-case, inavolisib plus palbociclib and fulvestrant resulted in 1.99 life-years and 1.43 QALYs at an incremental cost of $211,639.64 with an ICER of $106,595.61 per life-year and an ICUR of $148,417.37 per QALY. The utility value of progression-free survival was the most influential parameter on the base-case results. Alterations in each model parameter did not significantly impact on the conclusions. The probability of inavolisib plus palbociclib and fulvestrant was cost-effective at the WTP threshold of $150,000 was 54.59%. CONCLUSION: Inavolisib plus palbociclib and fulvestrant may be a high-value treatment option for patients with PIK3CA-mutated, HR + HER2-, advanced breast cancer in the USA.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.