SSMC BUDGET IMPACT OF ADJUVANT TRASTUZUMAB DERUXTECAN ACROSS THE HER2-POSITIVE EARLY BREAST CANCER PATHWAY: AN AFFORDABILITY MODEL FOR UAE PAYERS
Author(s)
Ammar Abdaljalil, BSc Pharm BCOP PgDip HTA1, Aref Chehal, MD2, Aydah Alawadhi, MD2, Dalia Mahmoud Elshourbagy, MD2, Aisha Mohamed Al Salami, MD2, Deepthi Vilasini Silymon, MD2.
1Pharmacy, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates, 2Oncology/Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
1Pharmacy, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates, 2Oncology/Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
OBJECTIVES: HER2-positive early breast cancer spans neoadjuvant, adjuvant, recurrence, and metastatic care. UAE payers need pathway-explicit budget-impact estimates that translate trial evidence into local five-year affordability for payer decisions.
METHODS: A five-year dynamic budget-impact model was built for a HER2-positive early breast cancer pathway, anchored to the validated 20-year cost-effectiveness result (ICER AED 348,225/QALY (US Int$ (PPP) 157,127), referenced only). It linked eligible patients, neoadjuvant TCHP (six cycles; docetaxel/carboplatin + dual HER2 blockade, NCCN v4.2026 preferred; surgery, pCR versus residual disease, adjuvant therapy, locoregional salvage, and metastatic treatment. Prespecified roles: current residual-disease T-DM1 standard; DESTINY-Breast05, adjuvant T-DXd replacing T-DM1; HER2CLIMB, distant-recurrence tucatinib + trastuzumab + capecitabine. Gross and net impact were reported separately under conservative (10-30%) and high (10-50%) adoption.
RESULTS: Over five years, adopting adjuvant T-DXd in place of T-DM1 for ~20 residual-disease patients/year produced a net incremental drug budget impact of AED 4.32M (US Int$ (PPP) 1.95M) under conservative adoption and AED 6.48M (Int$ 2.92M) under high adoption, equivalent to AED 215,891 per switched patient. T-DXd was associated with 85.6 fewer five-year recurrences/1,000 (185.0 vs 270.6; DESTINY-Breast05); a downstream-offset scenario reduced net impact to AED 3.98M (conservative). In one-way deterministic sensitivity analysis, results were most sensitive to T-DXd and T-DM1 acquisition prices (net AED 2.26M-6.37M at ±20% T-DXd price), remaining a positive incremental cost across all tested ranges.
CONCLUSIONS: This pathway-explicit, fully dynamic model offers a five-year affordability framework for UAE payers - not a reimbursement or formulary recommendation. Net impact is modest and scales with adoption and eligible-patient numbers; price and managed-entry are the principal levers. It is transferable by updating local epidemiology, prices, surgical/radiotherapy costs, and offset assumptions, and should be confirmed against local unit costs before payer use.
METHODS: A five-year dynamic budget-impact model was built for a HER2-positive early breast cancer pathway, anchored to the validated 20-year cost-effectiveness result (ICER AED 348,225/QALY (US Int$ (PPP) 157,127), referenced only). It linked eligible patients, neoadjuvant TCHP (six cycles; docetaxel/carboplatin + dual HER2 blockade, NCCN v4.2026 preferred; surgery, pCR versus residual disease, adjuvant therapy, locoregional salvage, and metastatic treatment. Prespecified roles: current residual-disease T-DM1 standard; DESTINY-Breast05, adjuvant T-DXd replacing T-DM1; HER2CLIMB, distant-recurrence tucatinib + trastuzumab + capecitabine. Gross and net impact were reported separately under conservative (10-30%) and high (10-50%) adoption.
RESULTS: Over five years, adopting adjuvant T-DXd in place of T-DM1 for ~20 residual-disease patients/year produced a net incremental drug budget impact of AED 4.32M (US Int$ (PPP) 1.95M) under conservative adoption and AED 6.48M (Int$ 2.92M) under high adoption, equivalent to AED 215,891 per switched patient. T-DXd was associated with 85.6 fewer five-year recurrences/1,000 (185.0 vs 270.6; DESTINY-Breast05); a downstream-offset scenario reduced net impact to AED 3.98M (conservative). In one-way deterministic sensitivity analysis, results were most sensitive to T-DXd and T-DM1 acquisition prices (net AED 2.26M-6.37M at ±20% T-DXd price), remaining a positive incremental cost across all tested ranges.
CONCLUSIONS: This pathway-explicit, fully dynamic model offers a five-year affordability framework for UAE payers - not a reimbursement or formulary recommendation. Net impact is modest and scales with adoption and eligible-patient numbers; price and managed-entry are the principal levers. It is transferable by updating local epidemiology, prices, surgical/radiotherapy costs, and offset assumptions, and should be confirmed against local unit costs before payer use.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA336
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Oncology