Cost-Minimization Analysis of Trastuzumab Intravenous Versus Trastuzumab Subcutaneous for the Treatment of Patients With HER2+ Early Breast Cancer And Metastatic Breast Cancer in Greece

Abstract

Objectives: Metastatic melanoma has a poor prognosis with 10 year survival being < 5%. Standard therapy is the effective but costly Ipilimumab. An emerging 1st line treatment is Tumor Infiltrating Lymphocytes (TIL), with response rates > 50% and expected survival rates of 25%-42% versus 45% (1yr) and 23,5% (2yr) for Ipilimumab. TIL is highly personalized, however complex and requests substantial upfront investments from the hospital in expensive lab-equipment, staff expertise and training, as well as extremely tight hospital logistics. Therefore, an early health economic modelling study, supporting a Coverage with Evidence Development (CED) program, was performed. MethOds: We used a Markov decision model to estimate the expected costs and outcomes (quality adjusted life years; QALYs) for TIL versus Ipilimumab in metastatic melanoma patients from a societal perspective over a life long time horizon. Three mutually exclusive health states (stable disease, progressive disease and death) were modelled, divided in first and second line treatment. Technical failures and non-compliance were incorporated to reflect the dynamic nature of the technology. To inform further research prioritization, Value of Information (VOI) analysis was performed. Results: TIL is expected to yield more QALYs compared to Ipilimumab (0.99 vs 0.52 respectively) at lower total costs (€ 83,588 vs € 87,834 respectively). Based on current information TIL has a probability of 88% for being cost effective at a cost/QALY threshold of € 30,000. Expected Value of Perfect Information (EVPI) amounted to € 1,2 million. Partial EVPI (EVPPI) was highest for survival data (€ 550,000). Expected Value of Sample information was estimated € 355,000 for an optimal sample size of n= 50. cOnclusiOns: TIL is expected to improve QALYs compared to Ipilimumab at lower incremental cost and has the highest probability of being cost-effective. To reduce decision uncertainty, a future clinical trial to investigate survival seems most valuable, and should preferably be undertaken as part of a CED program.

Efficacy and safety of subcutaneous trastuzumab and intravenous trastuzumab as part of adjuvant therapy for HER2-positive early breast cancer: Final analysis of the randomised, two-cohort PrefHer study

“…[5] A time-and-motion study within the PrefHer study demonstrated a mean time saving of 55-57 min of patient chair time and 13-17 min of active healthcare professional time per session with H SC compared with H IV, [6] and several countries have reported estimated increased hospital capacity and/or costsavings with H SC. [7][8][9][10][11][12][13][14][15][16][17] These data support a transition to SC delivery.…”

Real-World Data on Health-Related Quality of Life Assessment in Patients With Breast Cancer Receiving Subcutaneous Trastuzumab

“…Although we did not perform a specific cost analysis of the different treatment groups, a previous study has indicated that the cost of treatment with subcutaneous trastuzumab is lower than that with intravenous trastuzumab in the management of patients with early and metastatic breast cancer overexpressing HER2. 10 Hence, the substitution of the intravenous with subcutaneous formulation can produce valuable savings for the Greek health care system, especially in the current economic environment where hospitals’ pharmaceutical budget has significantly been reduced. 10 Furthermore, here, we do not provide a correlation of our results on HRQoL with patients’ survival parameters, as this study has a short time of follow-up and not enough events have occurred for such analysis.…”

“… 9 In addition to these advantages, the subcutaneous administration requires less preparation and administration expenses, manpower engagement, and day clinic time resulting in reduced health care system burden and costs. 10 The PrefHer study compared sequential subcutaneous trastuzumab for 4 cycles followed by intravenous trastuzumab and vice versa in patients with HER2+ early breast cancer and showed that the subcutaneous administration was both well tolerated and the preferred option between the 2 formulations. 11 …”

Economic Analysis of Intravenous vs. Subcutaneously Administered Trastuzumab for the Treatment of HER2+ Early Breast Cancer in Malaysia

“…The study estimated that over one year, switching to SC trastuzumab would result in a reduction of pharmacists and nurses workload by 5492 hours and generate cost savings of £271,000 [22]. Similarly, a study from Greece reported mean total cost per year of IV and SC trastuzumab was €24,163 and €23,042 per patient respectively; with the use of SC resulting in savings of €1121 [23]. Finally, a report from the Scottish Medicines Consortium indicated that switching from IV to SC trastuzumab would generate cost savings for the Scottish NHS of £3454 over one year of treatment arising from reductions in medication and time costs of health care professionals [25].…”