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 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 0.54. From healthcare system perspective, the ICER was CNY 127,578/QALY. Additional 9% lower indirect costs in PHT group resulting an ICER of CNY 117,147/QALY from the society perspective. Both ICERs were between 1~2 times GDP per capita, far below the local threshold of 3 times GDP per capita in 2018 (CNY 193,932). Acquisition cost of pertuzumab in PHT is partially offset by the prevention of disease recurrences over the time as the cost for managing recurrences was 10% lower than that in HT group. One-way sensitivity analysis demonstrated the results were robust. Probabilistic sensitivity analysis showed that PHT was more cost-effective in over 60% simulations at local threshold regardless of the perspective.

CONCLUSIONS : Compared to HT, PHT is more cost-effective in the neoadjuvant treatment of HER2-positive early or locally advanced breast cancer in China.