Abstract
Abstract Objectives: Addition of pertuzumab to trastuzumab and docetaxel (THP) results in significant clinical benefits for women with HER2-positive metastatic breast cancer. Despite evidence of important overall survival and quality of life improvements, for the Brazilian patients depending on the public health system chemotherapy alone (CT) remains the standard treatment. Previous request for trastuzumab incorporation was denied by Brazilian Ministry of Health (MoH) due to high individual costs. In an innovative way, the Brazilian Society of Clinical Oncology made a price negotiation directly with the pharmaceutical company, aiming to propose a formal request for the incorporation of these technologies to the National Committee for Health Technology Incorporation (CONITEC). Our objective was to evaluate the cost-effectiveness of THP versus CT in patients with HER2-positive advanced breast cancer, under the perspective of the Brazilian public health system. Methods: A cost-effectiveness analysis was conducted using a Markov model over a lifetime horizon. The model considers three health states: 1st-line treatment without progression; disease progression (with chemotherapy or best supportive care) and death. Transition probabilities and mortality rates were extracted from randomized studies. Costs of standard chemotherapy, complications, and surveillance were obtained from price tables regulated by the MoH. Pertuzumab and trastuzumab prices were those negotiated with the manufacturing company. Benefits are presented in life-years (LY) and costs in USD (using exchange rate for Brazilian Real to USD = 3.50). The relation between costs and benefits were used to present the incremental cost-effectiveness ratio (ICER) per life-year saved. We have performed one-way deterministic sensitivity analyses with cost of monoclonal antibodies to define the ideal price in Brazil. Results: Patients with HER2-positive metastatic breast cancer treated with CT were projected to have 1.87 LY, with a total cost of $12,118. THP was projected to increase the life expectancy of these patients by 1.48 years, with an incremental cost of $63,685 per patient. Thus, the ICER was $42,893 per LY-gained. Conclusions: The World Health Organization recommendation of three times gross domestic product per capita have defined our cost-effectiveness threshold. Despite the discount price, at a willingness-to-pay (WTP) threshold of $25,615 per LY, THP is not a cost-effective strategy compared to CT. An additional reduction around 58.67% in the pertuzumab price would be necessary to make THP cost-effective in Brazil. Discussion about the incorporation of trastuzumab to CT using the discount prices is in progress. Citation Format: Carvalho AC, Vasconcelos VCA, Sasse AD. Cost-effectiveness analysis of pertuzumab plus trastuzumab for advanced HER2-positive breast cancer in Brazil: A public health system perspective [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-06.
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