Presentation (CTI)

OBJECTIVES: Although HER-2 targeted therapy as neoadjuvant treatments have shown substantial clinical benefit globally, access in Indonesian public insurance remains limited. This study aimed to evaluate the cost effectiveness of subcutaneous pertuzumab plus trastuzumab with chemotherapy for women with high risk HER2 positive early breast cancer in the Indonesian context.
METHODS: A Markov model projected lifetime health outcomes and costs using efficacy data and cohort characteristics from the PEONY trial was developed. Cost inputs were calculated from Indonesia’s clinical practice guideline, national e catalogue and relevant Ministry of Health regulations. Sensitivity analysis, probabilistic analysis, and scenario analysis were conducted to evaluate the influence of parameter uncertainty and to examine the impact of alternative model assumptions.
RESULTS: The analysis generated lifetime costs of $42,119.74 for the subcutaneous pertuzumab plus trastuzumab with chemotherapy arm and $31,633.87 for chemotherapy alone. The incremental cost‑effectiveness ratio was $2,086.29 per QALY gained and $7,402.52 per life year gained, with price adjustment. Deterministic sensitivity analysis revealed that the model was particularly sensitive to the transition probability from invasive disease‑free survival to metastatic disease in non‑pCR patients. Probabilistic sensitivity analysis showed that the dual HER2‑targeted therapy was cost‑effective in 61% of simulations at a willingness‑to‑pay threshold equivalent to one times Indonesia’s GDP per capita. Scenario analysis indicated that patients diagnosed at age 35 represented the subgroup with the most favorable cost‑effectiveness profile.
CONCLUSIONS: In the Indonesian setting, pertuzumab plus trastuzumab administered subcutaneously in combination with chemotherapy considered cost effective compared to chemotherapy alone. The intervention appears most economically advantageous for women diagnosed at age 35.