Presentation (CTI)

OBJECTIVES: To build a cost-effectiveness evaluation of Pertuzumab for Her2-positive metastatic breast cancer, reusing the Brazilian public health system database.
METHODS: Records of procedures for breast cancer patients who underwent HER2 dual blockade were collected. Through record linkage, the complete treatment path of each patient was defined. Furthermore, the costs of chemotherapy, radiotherapy, hospitalization, consultations, and exams were extracted for each patient on a monthly basis, covering the period the patient remained in the database. Mortality data were extracted to differentiate between censored patients and those who died. A microsimulation model, using individual patient-level data, was build to estimate the average cost and life-years gained along each treatment path. Censored patients had their survival calculated based on the general population's survival, adjusted for their age. Patients were filtered by place of care, staging at diagnosis, and presence of prior treatment to verify the heterogeneity of the Incremental Cost-Effectiveness Ratio (ICER) across these subgroups.
RESULTS: A total of 4,570 patients were identified, with a mean initial age of 54 years. The time horizon in the model was 73 years, and the mean treatment time before censoring or death was 20 months. Patients who received Pertuzumab lived an average of 1.55 years longer and incurred an average additional cost of U$24,512.29. Considering public procurement prices (U$1,023.50/vial), Pertuzumab yielded an ICER of U$15,483.09 per life-year saved. This value is lower than the established cost-effectiveness threshold of U$19,090.90 per life-year saved.
CONCLUSIONS: This study demonstrated the feasibility of exploring the health system database through microsimulation with individual data for the construction of economic models to support decision-making regarding health technology incorporation.