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Background: Sacituzumab tirumotecan (Sac-TMT) has demonstrated survival benefits over chemotherapy in patients with previously treated metastatic triple-negative breast cancer (mTNBC). However, its economic value under different payment contexts in China remains uncertain. Methods: A state-transition (Markov) model was used to estimate lifetime costs and quality-adjusted life-years (QALYs) for Sac-TMT versus single-agent chemotherapy in second-line and later-line mTNBC. Clinical efficacy was derived from a phase III randomized trial, with survival extrapolated using parametric models. Cost-utility and price threshold analyses were conducted using willingness-to-pay (WTP) thresholds defined as three times the per-capita gross domestic product (GDP) at the national level and in economically underdeveloped regions. Scenarios incorporating patient assistance programs were also evaluated. Results: Sac-TMT increased QALYs but incurred substantially higher costs, resulting in incremental cost-effectiveness ratios exceeding both national and regional WTP thresholds at the current list price. To achieve cost-effectiveness, the price of Sac-TMT would need to be reduced to 48.3% of the current list price under the national WTP threshold and to 34.9% under the regional threshold. Although patient assistance programs increased the acceptable price range, Sac-TMT remained unlikely to be cost-effective at the list price. The reimbursed price following the 2025 national health insurance negotiation was markedly below these thresholds, suggesting improved economic value under current reimbursement conditions. Conclusion: Sac-TMT is unlikely to be cost-effective at its current list price for previously treated mTNBC in China. Substantial price reductions and reimbursement strategies may improve its economic value, particularly in economically underdeveloped regions.
Huo et al. (2026) studied this question.