The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data

Abstract

Background Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20–25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). Methods Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012–2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015–2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. Results AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR. Conclusions ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.

A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy

“…Although pertuzumab as neoadjuvant therapy is not really a novelty, the evidence of its value and cost is still limited. Our findings were in line with those reported in previous published studies [ 20 , 45 , 46 ]. Borges and colleagues found that the addition of pertuzumab as neoadjuvant therapy was associated with an increase of 40% of the overall costs per patient and an improvement of clinical outcomes (i.e., pCR response) [ 45 ].…”

“…Our findings were in line with those reported in previous published studies [ 20 , 45 , 46 ]. Borges and colleagues found that the addition of pertuzumab as neoadjuvant therapy was associated with an increase of 40% of the overall costs per patient and an improvement of clinical outcomes (i.e., pCR response) [ 45 ]. However, it should be noted that this was a real-world study including a small cohort of patients.…”

Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival

“…This can be burdensome and may lead to dehydration, electrolyte imbalances and sometimes hospitalization [ 1 , 24 ]. In addition, the costs of pertuzumab increase health care expenses [ 25 ]. Therefore, a high need remains to select patient in whom pertuzumab can be omitted.…”

Pertuzumab in Combination with Trastuzumab and Docetaxel in the Neoadjuvant Treatment for HER2-Positive Breast Cancer

“…This study follows two consecutive retrospective cohorts of women with HER2-positive breast cancer (≥ 18 years old) who received NeoT between January 2012 and June 2017 in the Breast Clinic of IPO-Porto. [ 23 ] This is a public hospital in the north of Portugal, integrated in the Porto Comprehensive Cancer Centre, specialized in the treatment and management of cancer. The Breast Clinic at IPO-Porto treated 1243 cases in 2017, making it the largest breast cancer treatment center in Portugal and one of the most relevant in Europe.…”