OBJECTIVES: Neoadjuvant (neo-adj) therapy is a treatment given prior to surgery of patients with early breast cancer (eBC). It makes breast-conserving surgery possible to be replaced with mastectomy. As shown in NeoSphere clinical trials, by receiving neo-adj treatment, it is possible to achieve pathological complete response (pCR). Pertuzumab as an add on to trastuzumab is a targeted therapy which is also used for neo-adj treatment of eBC patients with HER2+ mutation.

The objective of this study is to analyze the cost effectiveness of pertuzumab+trastuzumab against traztuzumab for neo-adj treatment of eBC in Turkish healthcare environment.

METHODS: A Markov model consisting of six health states (event-free, locoregional recurrence, remission, metastatic-not-progressed, metastatic-progressed and death) is used to perform health economic analysis. Clinical data from NeoSphere trial is used as clinical inputs and long-term outcomes of neo-adj treatment are estimated based on meta-analysis. Time horizon is selected as 50 years and all costs are calculated from Turkish payer perspective.

RESULTS: For the base scenario, incremental cost and QALY is found to be 3.894 TRY and 0,28, respectively. ICER was calculated as 13.759 TRY which is highly cost-effective in an environment where the CE threshold is ~170.000 TRY. The result is supported with different scenarios and probabilistic sensitivity analysis.

CONCLUSIONS: This study concludes that pertzumab+trastuzumab combination provides better clinical benefits by being highly cost-effective against trastuzumab treatment in the neo-adj setting of eBc patients. It is expected that pertuzumab treatment in neo-adj setting would result in better long term outcomes both for the patients and the payer in Turkish healthcare environment.