OBJECTIVES: Overall treatment costs in oncology are increasing rapidly due to the increasing availability of expensive drugs. Comparing the costs of currently used drugs and assessing the cost-effectiveness of new drugs requires a transparent overview of actual breast cancer treatment prices. As such an overview is lacking, this study aims to synthesize evidence on the reimbursement and costs to estimate the total treatment cost of expensive breast cancer drugs for the Netherlands.

METHODS: Evidence on the approval, reimbursement and list prices of expensive breast cancer drugs was identified from the Dutch Administrative Health Authority (ZINL). Data on the average length of treatment and dosing schedules was obtained from European Parliament Assessment Reports (EPARs) or ZINL reports. All evidence was aggregated in the estimation of actual treatment cost.

RESULTS: In the Netherlands, 31 breast cancer drugs are approved (available in 41 different forms). Based on drug list prices Pertuzumab, Trastuzumab Emtansine and Trastuzumab are the most expensive drugs. For 17/41 (41.5%), no evidence on the average treatment length was available in EPARs or ZINL reports. Comparing list prices to the estimated treatment cost per patient resulted in substantial differences in the ranking of expensiveness of the drugs. Overall, estimated treatment costs were highest for Bevacizumab, Pertuzumab and Trastuzumab Emtansine.

CONCLUSIONS: Estimating treatment costs is far from trivial, given the wide range of evidence sources that need to be synthesized. This complicates rapid and transparent assessment of actual cancer drug treatment cost, which is necessary to focus strategies aiming to limit the increasing healthcare costs. Differences exist in list prices within countries and between countries, thereby influencing the corresponding estimated treatment costs and resulting in list prices having limited value in this context. Therefore, extending standardization in presenting information on costs per cancer drug and implementing real world price estimates in such calculations is highly recommended