OBJECTIVES: To assess the cost-utility of pertuzumab added to neoadjuvant treatment with trastuzumab and docetaxel for patients with locally advanced, inflammatory, or early HER2-positive breast cancer (BC) in Russia. METHODS: Analysis was performed from the perspective of health care payer, comparing neoadjuvant treatment with pertuzumab+trastuzumab+docetaxel and trastuzumab+docetaxel. We developed Markov model with three states: «no progression», «progression» and «death», with life time horizon and cycle length of 4 weeks. Probability of progression was based on progression-free survival obtained from NeoSphere trial of neoadjuvant pertuzumab and trastuzumab. As no data on overall survival was available, probability of death in progression was based on results of study by Slamon et al (treatment of progressive metastatic HER-2 positive BC) and in no-progression state it was the same as in general population. Utilities were derived from published literature. Only costs of chemotherapy were included into the model, based on treatment regimens in NeoSphere trial, real practice data on treatment of metastatic HER2-positive BC in Russia and registered prices for medications. Results were discounted at 3,5%. Costs were converted into EURO using the average annual exchange rate in 2015 (1 EURO=67.7767 RUR). RESULTS: The results of modelling demonstrated that costs for cohort of patients treated with neoadjuvant pertuzumab, trastuzumab and docetaxel were higher (€15,548), and additional 1.06 QALY were gained. ICER was €14,645 per QALY, which is below the willingness to pay threshold used in Russia (three times the national annual GDP per capita, €24,344 in 2015). Probabilistic sensitivity analysis (1000 simulations) showed that addition of pertuzumab to neoadjuvant treatment remained a cost-effective option in 63,4% simulations. CONCLUSIONS: There is a high probability that neoadjuvant treatment with pertuzumab, trastuzumab and docetaxel is an efficient option for treating patients with locally advanced, inflammatory, or early HER2-positive breast cancer in Russian health care setting