HEALTHCARE SYSTEM SUSTAINABILITY IN ECUADOR: A COST-MINIMIZATION ANALYSIS OF FIXED-DOSE SUBCUTANEOUS PERTUZUMAB AND TRASTUZUMAB VERSUS INTRAVENOUS ADMINISTRATION IN HER2-POSITIVE BREAST CANCER
Author(s)
Paula S. Luque, Sr., B.S.Econ.1, Sergio Cáceres Caceres, MSc2, David Quitian, MSc3, Moreno Andrea, Dra.4, Néstor Ochoa, B.S.5.
1Manager, Roche, Buenos Aires, Argentina, 2Roche, Bogotá, Colombia, 3Roche, Bogota, Colombia, 4Hospital Eugenio Espejo, Quito, Ecuador, 5Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador.
1Manager, Roche, Buenos Aires, Argentina, 2Roche, Bogotá, Colombia, 3Roche, Bogota, Colombia, 4Hospital Eugenio Espejo, Quito, Ecuador, 5Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador.
OBJECTIVES: This study aims to assess the economic impact of transitioning from separate intravenous infusions of pertuzumab and trastuzumab to their subcutaneous fixed-dose combination (Phesgo) for HER2-positive breast cancer treatment in Ecuador. Utilizing a cost-minimization framework, the analysis evaluates shifts in direct medical costs, healthcare provider time allocation, and medical consumable utilization.
METHODS: A cost-minimization analysis using micro-costing framework was developed for Ecuador's public healthcare network. The eligible cohort of HER2-positive breast cancer patients was estimated using national population projections and global incidence data. Direct costs were measured by evaluating medical consumables and active healthcare professional time required for treatment preparation, infusion, and monitoring, with parameters defined by a clinical expert panel. Costs were derived from official national public procurement prices and public sector salary scales from Ecuadorian Ministries of Health and Labor.
RESULTS: Total eligible cohort included 872 patients (403 in neoadjuvance, 242 in adjuvance, 161 in metastatic). Total per-patient direct medical costs were USD 4,046 for intravenous therapy and USD 544 for subcutaneous fixed-dose combination (Phesgo). At population level, cohort burden was USD 1,827,583 for intravenous versus USD 232,406 for subcutaneous therapy, representing a 87.28% reduction in the financial burden for HER2-positive breast cancer treatment. Per cycle, average infusion and observation time decreased from 216 minutes (3.6 hours) to 21 minutes (0.35 hours), yielding a 90.28% operational reduction in infrastructure occupancy. Chair-turnover analysis demonstrated that this time-release allows 10 subcutaneous patients to be treated in the same chair and time frame previously required by a single intravenous cycle.
CONCLUSIONS: Transitioning to the subcutaneous combination in Ecuador optimizes staff time and expands saturated infusion room capacity without infrastructure investments. By reducing costs and hospitalization times, this strategy lowers operational pressure, alleviates budget constraints, and improves patient quality of life.
METHODS: A cost-minimization analysis using micro-costing framework was developed for Ecuador's public healthcare network. The eligible cohort of HER2-positive breast cancer patients was estimated using national population projections and global incidence data. Direct costs were measured by evaluating medical consumables and active healthcare professional time required for treatment preparation, infusion, and monitoring, with parameters defined by a clinical expert panel. Costs were derived from official national public procurement prices and public sector salary scales from Ecuadorian Ministries of Health and Labor.
RESULTS: Total eligible cohort included 872 patients (403 in neoadjuvance, 242 in adjuvance, 161 in metastatic). Total per-patient direct medical costs were USD 4,046 for intravenous therapy and USD 544 for subcutaneous fixed-dose combination (Phesgo). At population level, cohort burden was USD 1,827,583 for intravenous versus USD 232,406 for subcutaneous therapy, representing a 87.28% reduction in the financial burden for HER2-positive breast cancer treatment. Per cycle, average infusion and observation time decreased from 216 minutes (3.6 hours) to 21 minutes (0.35 hours), yielding a 90.28% operational reduction in infrastructure occupancy. Chair-turnover analysis demonstrated that this time-release allows 10 subcutaneous patients to be treated in the same chair and time frame previously required by a single intravenous cycle.
CONCLUSIONS: Transitioning to the subcutaneous combination in Ecuador optimizes staff time and expands saturated infusion room capacity without infrastructure investments. By reducing costs and hospitalization times, this strategy lowers operational pressure, alleviates budget constraints, and improves patient quality of life.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE540
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology