OBJECTIVES : To estimate the cost-effectiveness of pertuzumab with trastuzumab and chemotherapy (PHT) vs. trastuzumab and chemotherapy (HT) in the neoadjuvant treatment of HER2-positive early or locally advanced breast cancer after National Drug Reimbursement List Adjustment in China.

METHODS : A validated 6-state Markov model with monthly cycle was constructed to estimate the lifetime incremental cost-effectiveness ratio (ICER). Efficacy and safety data considered in the model were derived from the NeoSphere trial and other published studies. Utilities were taken from EQ-5D results of Chinese patients with HER2-positive early breast cancer and published literatures. The modelled cost comprised drugs, administration, adverse events management, follow-up and therapeutic costs. Furthermore, indirect costs were included when analyzed from the society perspective. All costs were obtained from real world data and local published resources. Costs and outcomes were both discounted at 5%. Sensitivity analysis were conducted to verify the robustness of the results.

RESULTS : PHT had an added QALY of 0.52 and saved CNY 306 from healthcare system perspective. Additional 10% indirect costs (CNY 6,719) in PHT group could be saved from the society perspective. PHT dominated HT from both perspectives. Acquisition cost of pertuzumab in PHT is entirely offset by the prevention of disease recurrences over the time due to lower recurrence rate in PHT than it in HT. One-way sensitivity analysis demonstrated the results were robust. Probabilistic sensitivity analysis showed that PHT was more cost-effective in over 80% simulations at local threshold of 3 times GDP per capita in 2019 (CNY 212,946) regardless of the perspective.

CONCLUSIONS : Compared to HT, PHT is more cost-effective as the neoadjuvant treatment of HER2-positive early or locally advanced breast cancer after National Drug Reimbursement List adjustment in China.