Unveiling the Economic Landscape: Burden of HR/HER2 Locally Recurrent Inoperable or Metastatic Breast Cancer
Author(s)
Amin Haiderali, MBA, MPH1, Jagadeswara Rao Earla, MBA, PharmD, PhD2, Jyothsna Nathani, PharmD3, Priyanka Singh, M. Pharm.4, Sugandh Sharma, MSc4.
1Merck, North Wales, PA, USA, 2Merck & Co. Inc, Rahway, NJ, USA, 3Parexel International, Bengaluru, India, 4Parexel International, Chandigarh, India.
1Merck, North Wales, PA, USA, 2Merck & Co. Inc, Rahway, NJ, USA, 3Parexel International, Bengaluru, India, 4Parexel International, Chandigarh, India.
OBJECTIVES: Hormone receptor-positive (HR+)/ human epidermal growth factor receptor 2-negative (HER2-) comprises 65-75% of all breast cancer (BC) cases. This study aimed to summarize economic burden associated with HR+/HER2- locally recurrent inoperable or metastatic BC.
METHODS: A PRISMA-compliant systematic literature review was conducted to identify English language studies published till July 2024. Embase, MEDLINE, and HTA databases were searched along with recent conference proceedings (2021-2024) and relevant reviews to identify and summarize the evidence.
RESULTS: Seven economic modelling studies across USA (2), Europe (2), and Middle East (3) assessed cost-effectiveness of treatments for HR+/HER2- advanced or metastatic BC patients who progressed on prior therapy. Compared to Palbociclib (P) + Fulvestrant (F), Alpelisib (A) + F was cost-effective in PIK3CA-mutated patients in Qatar (ICER: $45,490/QALY) and was dominant in Oman and Türkiye. A+F was also cost-effective compared to Everolimus+Exemestane in Oman (ICER: $117,177/QALY) and Qatar (ICER: $147,657/QALY). However, in the USA, A+F wasn't cost-effective against placebo + F (ICER: $340,153/QALY). Three HTA appraisals from NICE, SMC and CADTH on A+F and one from CADTH on Sacituzumab govitecan were identified. A+F was considered cost-effective versus Everolimus+Exemestane by NICE (ICER: £49,907/QALY). A+F versus standard care was not considered cost-effective by SMC (ICER: £70,027/QALY) and CADTH (ICER: $319,592/QALY). Sacituzumab govitecan was also not cost-effective against TPC (ICER: $506,807/QALY). Thirty-eight cost and resource use studies were identified across the USA (20), Europe (9) and other regions (9). The proportion of patients with at least one hospitalization, outpatient visit, or emergency room visit ranged from 55.8-83.1%, 90.2-99.8%, and 35.4-81.1%, respectively. Total healthcare costs in the USA, ranged from $7,271 to $16,075 per patient per month during 2006 to 2014.
CONCLUSIONS: HR+/HER2- locally recurrent inoperable or metastatic BC presents a significant economic burden, with high healthcare resource utilization and costs, emphasizing the need to balance clinical efficacy with cost-effectiveness.
METHODS: A PRISMA-compliant systematic literature review was conducted to identify English language studies published till July 2024. Embase, MEDLINE, and HTA databases were searched along with recent conference proceedings (2021-2024) and relevant reviews to identify and summarize the evidence.
RESULTS: Seven economic modelling studies across USA (2), Europe (2), and Middle East (3) assessed cost-effectiveness of treatments for HR+/HER2- advanced or metastatic BC patients who progressed on prior therapy. Compared to Palbociclib (P) + Fulvestrant (F), Alpelisib (A) + F was cost-effective in PIK3CA-mutated patients in Qatar (ICER: $45,490/QALY) and was dominant in Oman and Türkiye. A+F was also cost-effective compared to Everolimus+Exemestane in Oman (ICER: $117,177/QALY) and Qatar (ICER: $147,657/QALY). However, in the USA, A+F wasn't cost-effective against placebo + F (ICER: $340,153/QALY). Three HTA appraisals from NICE, SMC and CADTH on A+F and one from CADTH on Sacituzumab govitecan were identified. A+F was considered cost-effective versus Everolimus+Exemestane by NICE (ICER: £49,907/QALY). A+F versus standard care was not considered cost-effective by SMC (ICER: £70,027/QALY) and CADTH (ICER: $319,592/QALY). Sacituzumab govitecan was also not cost-effective against TPC (ICER: $506,807/QALY). Thirty-eight cost and resource use studies were identified across the USA (20), Europe (9) and other regions (9). The proportion of patients with at least one hospitalization, outpatient visit, or emergency room visit ranged from 55.8-83.1%, 90.2-99.8%, and 35.4-81.1%, respectively. Total healthcare costs in the USA, ranged from $7,271 to $16,075 per patient per month during 2006 to 2014.
CONCLUSIONS: HR+/HER2- locally recurrent inoperable or metastatic BC presents a significant economic burden, with high healthcare resource utilization and costs, emphasizing the need to balance clinical efficacy with cost-effectiveness.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE745
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology