OBJECTIVES: To conduct a cost – effectiveness analysis comparing combination therapy with pertuzumab, trastuzumab and docetalex (PTD) with trastuzumab and docetaxel (TD) only for neoadjuvant treatment of patients with locally advanced, inflammatory, or early HER2-positive breast cancer in Greece. METHODS: A Markov model, comprising six health states, was developed to describe disease progression and evaluate the cost and consequences of the comparators. Efficacy and safety data considered in the model were extracted from the relevant randomized Phase II clinical trials and other published studies. Utilities values were extracted from the literature. Direct medical costs were incorporated in the model reflecting the year 2015. The model evaluated the comparators over a lifetime horizon in the course of a 1-month cycle. Probabilistic sensitivity analysis was conducted to account for uncertainty and variation in the parameters of the model. The analysis was performed from a payer’s perspective. Costs and outcomes that occurred beyond one year were discounted at a 3.5% annual rate which is the standard practice in Greece as well as other jurisdictions. RESULTS: Total lifetime cost per patient for PTD was estimated at 98,126€ and for TD at 93,980€. On average patients treated with PTD are estimated to live for 16.65 years, that is 0.35 years and 0.30 quality adjusted life years over those on TD. Probabilistic analysis confirmed the deterministic results. Based on the above outcomes, the resulting cost-effectiveness ratios associated with the administration of PTD were 11,734€ per life-year gained and 12,090€ per QALY gained. CONCLUSIONS: Results suggest that PTD represents a cost - effective alternative relative to TD for neoadjuvant treatment of patients with locally advanced, inflammatory, or early HER2-positive breast cancer in Greece.