Economic Evaluations Cost and Resource Utilization in Early Triple-Negative and Low Hormone Receptor-Positive Breast Cancer: A Comprehensive Systematic Review
Author(s)
Amin Haiderali, MBA, MPH1, Jagadeswara Rao Earla, MBA, PharmD, PhD2, Jyothsna Nathani, PharmD3, Asheer Dovari, M. Pharm.4, Sugandh Sharma, MSc5.
1Merck, North Wales, PA, USA, 2Merck & Co. Inc, Rahway, NJ, USA, 3Parexel International, Bengaluru, India, 4Parexel International, Mumbai, India, 5Parexel International, Chandigarh, India.
1Merck, North Wales, PA, USA, 2Merck & Co. Inc, Rahway, NJ, USA, 3Parexel International, Bengaluru, India, 4Parexel International, Mumbai, India, 5Parexel International, Chandigarh, India.
OBJECTIVES: Triple-negative breast cancer (TNBC) which lacks expression of hormone receptor (HR) and Human Epidermal growth factor Receptor 2 (HER2), and HR- low positive (HR ≤ 5% by immunohistochemistry) HER2- BC are aggressive subtypes with significant economic implications. This review synthesized evidence on economic evaluations, healthcare resource utilization (HRU), and costs associated with adjuvant therapy in these populations.
METHODS: A systematic literature review was conducted across multiple databases published in English through October 2024. Data on economic evaluations, costs, and HRU were extracted and analyzed.
RESULTS: Four economic evaluations were identified across Sweden, Spain, Portugal, and the UK. In Sweden, adjuvant olaparib was found to be cost-effective for gBRCA1/2-mutated, high-risk, HER2-negative early breast cancer, with an ICER of 371,651 SEK/QALY and a 99.8% probability of being cost-effective at a willingness-to-pay threshold of 1,000,000 SEK/QALY compared to watch and wait (WaW). Similar findings were reported in Spain (ICER: €39,084/QALY) and Portugal (ICER: €38,917/QALY) for adjuvant olaparib versus WaW. In the UK, adding bevacizumab to adjuvant chemotherapy for early TNBC showed potential cost-effectiveness. Twenty cost/HRU studies were identified. Hospitalization rates ranged from 26% hospitalized during the time between neoadjuvant treatment and surgery to 30% experiencing at least one hospitalization within a year. Outpatient visit rates ranged from 43% to 99%. Mean inpatient admissions were 1.1-2.3 per patient per year (PPPY), with average lengths of stay between 4-11 days PPPY. Total direct costs for TNBC in 2010 varied from $76,825-$95,338 PPPY. In 2019, the annual cost of TNBC recurrence in the USA was $1.32 billion. HRU/costs increased with disease progression and recurrence.
CONCLUSIONS: This review highlights the significant economic burden with early TNBC, while evidence specific to HR-low positive HER2- BC was scarce. Despite some adjuvant therapies demonstrating cost-effectiveness, high recurrence and progression costs emphasize the need for effective interventions to optimize outcomes and resource allocation.
METHODS: A systematic literature review was conducted across multiple databases published in English through October 2024. Data on economic evaluations, costs, and HRU were extracted and analyzed.
RESULTS: Four economic evaluations were identified across Sweden, Spain, Portugal, and the UK. In Sweden, adjuvant olaparib was found to be cost-effective for gBRCA1/2-mutated, high-risk, HER2-negative early breast cancer, with an ICER of 371,651 SEK/QALY and a 99.8% probability of being cost-effective at a willingness-to-pay threshold of 1,000,000 SEK/QALY compared to watch and wait (WaW). Similar findings were reported in Spain (ICER: €39,084/QALY) and Portugal (ICER: €38,917/QALY) for adjuvant olaparib versus WaW. In the UK, adding bevacizumab to adjuvant chemotherapy for early TNBC showed potential cost-effectiveness. Twenty cost/HRU studies were identified. Hospitalization rates ranged from 26% hospitalized during the time between neoadjuvant treatment and surgery to 30% experiencing at least one hospitalization within a year. Outpatient visit rates ranged from 43% to 99%. Mean inpatient admissions were 1.1-2.3 per patient per year (PPPY), with average lengths of stay between 4-11 days PPPY. Total direct costs for TNBC in 2010 varied from $76,825-$95,338 PPPY. In 2019, the annual cost of TNBC recurrence in the USA was $1.32 billion. HRU/costs increased with disease progression and recurrence.
CONCLUSIONS: This review highlights the significant economic burden with early TNBC, while evidence specific to HR-low positive HER2- BC was scarce. Despite some adjuvant therapies demonstrating cost-effectiveness, high recurrence and progression costs emphasize the need for effective interventions to optimize outcomes and resource allocation.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE395
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology