Presentation (CTI)

OBJECTIVES: HER2+ breast cancer (BC) is a major health concern in Trinidad and Tobago, with 570 new cases reported in 2022 representing 29% of female cancers. This study aims to estimate the economic burden of this type of cancer and analyze the epidemiological and cost impact of HER2+ targeted therapies.
METHODS: A Delphi panel, bottom-up cost analysis was conducted with the medical oncologic team of the Cancer Centre of Trinidad and Tobago, to assess real-world HER2+ BC management. Experts evaluated the probability and frequency of resource use to capture management variations within healthcare systems. Public tender award prices, reports and private sector pricing obtained HER2 + BC management costs (USD2024). A population estimation model was performed to determine the impact of targeted HER2+ therapies in early BC avoided relapses, prevented metastases, life-years gained, quality-adjusted life-years , and metastatic BC cost reduction, comparing a base scenario (chemotherapy alone) vs actual scenario (Chemotherapy and Trastuzumab) vs ideal (Chemotherapy, Trastuzumab, Pertuzumab & Trastuzumab+Emtansine).
RESULTS: The average-annual-cost of healthcare for a patient with HER2+ BC (actual-scenario) in neoadjuvant, adjuvant, in first and second line metastatic disease are noted as follows USD42,480.14; USD42,715.22, USD62,769.26, USD35,349.80; respectively. The disease-targeted therapies in the actual and ideal scenario for Trinidad and Tobago in 2024 resulted in 5 & 10 recurrences avoided respectively vs chemotherapy alone. Additionally, this would have resulted in the prevention of 5 cases of metastatic disease in the actual scenario with 9 in the ideal. The actual vs ideal setting would have 133 vs 256 LYs gained and 105 vs 203 QALYs gained respectively. Thus leading to a savings of USD512,209 vs USD923,923, respectively.
CONCLUSIONS: Metastatic HER2+ BC management incurs higher costs than neoadjuvant or adjuvant stages. Targeted therapies improve patient outcomes by preventing metastases, increasing LY’s and QALY’s, and reducing costs associated with advanced disease.