A cost-effectiveness analysis from the US payer perspective concludes that adding capivasertib to fulvestrant is not cost-effective at the current price in patients with HR+/HER2- advanced breast cancer with PI3K/AKT/PTEN pathway alterations.
What was known
Capivasertib plus fulvestrant has emerged as a promising targeted therapy for HR+/HER2- advanced breast cancer. Its cost-benefit balance in the subgroup of patients with PI3K/AKT/PTEN pathway alterations had not been assessed from a health system perspective.
What this work adds
The authors developed a partitioned survival model with three health states (progression-free, progressive disease and death) over a 5-year time horizon. Progression-free and overall survival data were derived from the CAPItello-291 trial (NCT04305496). Utilities, disutilities and direct medical costs were taken from published literature and the Centers for Medicare and Medicaid Services; capivasertib cost was based on wholesale acquisition cost. Costs were expressed in 2025 US dollars and both costs and outcomes were discounted at 3%. Incremental cost-effectiveness ratios per quality-adjusted life-year (QALY) and per equal value of life years gained were compared, with a willingness-to-pay threshold of $150,000.
Main results
Capivasertib plus fulvestrant yielded more QALYs (1.89 vs 1.29) and more life years (3.31 vs 2.49), but at a higher cost ($539,625 vs $158,679), resulting in ratios of $636,455 per QALY and $459,358 per life year gained over five years. The price of capivasertib ($28,332 per 4 weeks) had the greatest impact: to reach the $150,000 threshold it would need to fall to $5,598, a reduction of about 80%.
What it means
Although the combination offers clinical benefit, its current cost places it above the cost-effectiveness threshold, forcing health systems to decide how to fund it. The results depend on extrapolated survival data and the US pricing context, so they should be interpreted cautiously when transferred to other settings.
Reference: Liang X, Malone DC, Tan CJ. Cost-effectiveness analysis of capivasertib plus fulvestrant in the PIK3CA/AKT1/PTEN-altered subgroup with HR+/HER2- advanced breast cancer: a United States payer perspective. Journal of Medical Economics, 2026. DOI.
