OBJECTIVES: To evaluate the cost-effectiveness and cost-utility of pertuzumab in combination with trastuzumab and docetaxel (PTD) compared to trastuzumab and docetaxel (TD) as neoadjuvant treatment in women with locally advanced, inflammatory or early stage HER2 positive breast cancer in the Portuguese National Health Service (NHS) and societal perspectives. METHODS: A Markov model was developed comprising six stages to estimate lifetime (50 years) costs and outcomes – quality adjusted life years (QALYs) and life years (LYs). Transition probabilities to progressive disease and death as well as adverse events (AE) rates were based on data from NeoSphere trial (Gianni L; 2016). Mortality rates were extrapolated for the first seven years survival period; thereafter, mortality rate from the general population was applied. Utilities were obtained from a Swedish study (Lidgren M; 2007). Costs of drugs, AE management, supportive care, loss of productivity and demographics were collected from official Portuguese sources. Annual discount rate of 5% was considered for both costs and consequences. One-way sensitivity analysis was conducted to explore the influence of the following variables in the results: annual discount rate, use of demographics from NeoSphere trial, use of Canadian utilities (Hedden L; 2012) and by when general population mortality was applied. RESULTS: When compared to TD, PTD presented incremental LYs, QALYs and costs: 0.31, 0.26 and 6.424€, respectively. In the base case analysis, each LY and QALY gained costs 20,957€ and 24,428€, respectively. Sensitivity analysis shows that results are mainly sensitive to discount rate, demographics and to the timepoint at which general population mortality is applied. CONCLUSIONS: In the neoadjuvant therapy, the use of PTD was found to imply added costs per LY and per QALY (ICER < 25,000€) that are generally accepted in Portugal.