COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF DUAL HER2 BLOCKADE IN HIGH-RISK HER2-POSITIVE EARLY BREAST CANCER IN INDONESIA PERSPECTIVE
Author(s)
Alex B. Koro, MPH1, Nina Lianawati, PhD1, Gassani Amalia, MSc, MD2, Dedy Hermansyah, PhD., MD3, Wulyo Rajabto, MD4, Rizky Ifandriani Putri, PhD, MD5, Yennita Bastian, B.Pharm, Pharmacist2, Gerardo Machnicki, BA, MSc, PhD6, Didik Setiawan, PhD1.
1Center for Health Economics Studies (CHES), Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia, 2Roche Indonesia, Jakarta, Indonesia, 3Surgery, Department of Surgery, Oncology Division, Faculty of Medicine, Universitas Sumatera Utara, Sumatera Utara, Indonesia, 4Department of Internal Medicine, Hematology-Oncology Division, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 5Dharmais National Cancer Center, Jakarta, Indonesia, 6F. Hoffmann-La Roche Ltd, Basel, Switzerland.
1Center for Health Economics Studies (CHES), Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia, 2Roche Indonesia, Jakarta, Indonesia, 3Surgery, Department of Surgery, Oncology Division, Faculty of Medicine, Universitas Sumatera Utara, Sumatera Utara, Indonesia, 4Department of Internal Medicine, Hematology-Oncology Division, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 5Dharmais National Cancer Center, Jakarta, Indonesia, 6F. Hoffmann-La Roche Ltd, Basel, Switzerland.
OBJECTIVES: Human epidermal growth factor receptor‑2 (HER2) overexpression occurs in 15-20% of breast cancer cases and is associated with more aggressive disease diseases and poorer clinical outcomes. In Indonesia, the clinical and economic burden of HER2‑positive early breast cancer (EBC) remains substantial. While dual HER2 blockade has demonstrated clinical benefits, its economic value within the Indonesian healthcare system requires further evaluation. This study evaluates the cost-effectiveness and budget impact of subcutaneous pertuzumab-trastuzumab in combination with chemotherapy in both neoadjuvant and adjuvant settings for high-risk HER2-positive EBC.
METHODS: A cohort-based Markov model was developed to estimate lifetime costs and health outcomes from the healthcare payer perspective. Clinical efficacy inputs were primarily derived from the PEONY trial and supplemented with published literature. Costs inputs were obtained from national clinical guidelines, the Indonesian e-catalogue, and relevant Ministry of Health regulations. Health outcomes were expressed in quality-adjusted life years (QALYs), and cost effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs). Deterministic sensitivity analysis was performed to assess parameter uncertainty. A separated budget impact analysis was performed using a population-based approach over five-year time horizon, incorporating projected uptakes rates.
RESULTS: In the neoadjuvant setting, dual HER2 blockade yielded an ICER of USD1,599.53 per QALY gained. In the adjuvant continuation setting, the ICER was USD $1,733.99 per QALY gained. Sensitivity analyses indicated that pathological complete response (pCR) rate, patient age at diagnosis, and time horizon as key drivers of the model outcomes. The budget impact analysis estimated an additional cumulative cost of USD33.0 million for the neoadjuvant setting and USD60.8 million for adjuvant continuation over five years.
CONCLUSIONS: Pertuzumab-trastuzumab in combination with chemotherapy is likely to be a cost‑effective strategy for high‑risk HER2‑positive early breast cancer in Indonesia. Nonetheless, its implementation should be carefully considered alongside budgetary constraints and health system priorities.
METHODS: A cohort-based Markov model was developed to estimate lifetime costs and health outcomes from the healthcare payer perspective. Clinical efficacy inputs were primarily derived from the PEONY trial and supplemented with published literature. Costs inputs were obtained from national clinical guidelines, the Indonesian e-catalogue, and relevant Ministry of Health regulations. Health outcomes were expressed in quality-adjusted life years (QALYs), and cost effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs). Deterministic sensitivity analysis was performed to assess parameter uncertainty. A separated budget impact analysis was performed using a population-based approach over five-year time horizon, incorporating projected uptakes rates.
RESULTS: In the neoadjuvant setting, dual HER2 blockade yielded an ICER of USD1,599.53 per QALY gained. In the adjuvant continuation setting, the ICER was USD $1,733.99 per QALY gained. Sensitivity analyses indicated that pathological complete response (pCR) rate, patient age at diagnosis, and time horizon as key drivers of the model outcomes. The budget impact analysis estimated an additional cumulative cost of USD33.0 million for the neoadjuvant setting and USD60.8 million for adjuvant continuation over five years.
CONCLUSIONS: Pertuzumab-trastuzumab in combination with chemotherapy is likely to be a cost‑effective strategy for high‑risk HER2‑positive early breast cancer in Indonesia. Nonetheless, its implementation should be carefully considered alongside budgetary constraints and health system priorities.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE14
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Oncology