Background: Breast cancer is highly prevalent worldwide and leads to high health-care costs. HER2-positive subtype represents 30% of all breast cancers and is associated with a poor prognosis. Patients treated with anti-HER2 therapies frequently develop resistance and require pharmacological treatment change. Liquid biopsy is a minimally invasive and an easily accessible technique, with high sensitivity and specificity, to detect molecular treatment resistance even before the onset of clinical manifestations and can thus be used to reduce unnecessary anti-HER2 treatment costs. Objective: To evaluate the cost-effectiveness of using liquid biopsy (ctDNA detection) to determine treatment change in women with HER2-positive advanced breast cancer in Colombia. Methodology: We performed an economic evaluation using decision tree modeling and deterministic analyses based on literature search for first and second lines of treatment (trastuzumab, pertuzumab, docetaxel, and TDM1); resistance; outcomes; and sensitivity and specificity of tests detecting molecular resistance. The effectiveness was measured using quality-adjusted life year (QALY) score, and costs were obtained from databases with national validity, suppliers, the Colombian Drug Price Information System (SISMED), and local studies. Results: The use of liquid biopsy (ctDNA detection) with conventional treatment was more expensive and less effective than conventional treatment without liquid biopsy (US $177,985.35 and 0.533889206 QALY, respectively). The incremental cost with liquid biopsy was US $7,333.17 and the incremental effectiveness was 0.00042256 QALY relative to the conventional method. Conclusion: Including liquid biopsy in the treatment of HER2-positive advanced breast cancer was considered currently inapplicable in Colombia because it was not cost effective. Our results open a window of opportunity to improve the development and implementation of ctDNA testing in Colombia, potentially reducing current costs. More evidence is required on the utility of this test, depending on the financial capacity of Colombia and other countries.

ResumenLa salud materno-perinatal es un área de interés en la investigación en salud y un reto en la práctica médica. La reducción de la mortalidad y de la morbilidad materna y en la población pediátrica es un problema de salud pública en nuestro país, fue uno de los objetivos del desarrollo del milenio y, actualmente, es parte de los objetivos de desarrollo sostenible de las Naciones Unidas.Por esta razón, surge la necesidad de profundizar en el tema y comprender los factores que influyen en las complicaciones del embarazo, la salud del recién nacido y los posibles desenlaces adversos de la gestación.Colombia ha estado siempre comprometida en reducir las cifras de mortalidad materna e infantil, implementando el desarrollo y la aplicación de guías de práctica clínica y protocolos de atención.Palabras clave: salud materna, embarazo, salud pública, mortalidad materna, mortalidad perinatal.Keywords: Maternal health, pregnancy, public health, maternal mortality, perinatal mortality. AbstractPerinatal and maternal health has been a subject of interest in health research and a challenge in medical practice. Decreasing maternal and perinatal mortality and morbidity is an important public health problem in our country that was part of the Millennium Development Goals and currently is part of the Sustainable Development Goals of the United Nations. For this reason, further research on this topic is needed specifically on understanding the factors that influence pregnancy complications, the health of the newborn and the possible outcomes of pregnancy. Colombia has always been committed to reducing maternal and infant mortality, implementing and enforcing clinical practice guidelines and protocols.Págs. ResumoA saúde materna perinatal é uma área de interesse da pesquisa em saúde e um desafio na prática médica. Diminuir a mortalidade e morbilidade materna e da população pediátrica é um problema de saúde pública no nosso país que foi um dos objetivos de Desenvolvimento do Milênio e atualmente faz parte dos objetivos de desenvolvimento sustentável das Nações Unidas. Por esse motivo surge a necessidade de aprofundar no tema e compreender os fatores que influem nas complicações da gravidez e na boa saúde do recém-nascido, mesmo como nos possíveis desenlaces adversos da gestação. Colômbia tem estado sempre comprometida com a redução das cifras de mortalidade materna e infantil, implementando as guias de prática clínica e protocolos de atenção.Palavras chave: saúde materna, gravidez, mortalidade materna, mortalidade perinatal IntroducciónLa investigación en salud ha sido una de las grandes herramientas a la hora de proponer políticas en salud y mejorar la calidad de vida de las personas. Es por esta razón que, en la actualidad, muchas instituciones de salud y de educación superior aúnan esfuerzos para indagar en los aspectos que más afectan y preocupan a sus poblaciones. Con base en los resultados de dichas investigaciones, los profesionales de la salud se ven en la capacidad de proporcionar diagnósticos más certeros y mejores a...