OBJECTIVES: The aim of this economic analysis is to compare the total cost of subcutaneous trastuzumab (SC-TRA) vs intravenous trastuzumab (IV-TRA) for HER2-positive breast cancer patients at the Oncology Department at Clinical Center of Montenegro. HannaH study showed that SC-TRA has a pharmacokinetic profile and efficacy non-inferior to standard IV-TRA and is a valid alternative for the treatment of eligible breast cancer patients.

METHODS: A cost-minimization analysis was performed using data from market research from 2016 and an administration time analysis. Total time and cost of both types of TRA administration were quantified in a time horizon of over 18 cycles therapy course. 55 patients (mean weight 72 kg) from the Oncology clinic were included in this analysis. Patients were HER2-positive and received the drug in the adjuvant (72 patients) or metastatic (19 patients) setting. Drug cost (direct costs) included only drug treatment per mean patient weight, and non- drug (indirect) costs included chair time treatments, daily hospital fee, active healthcare professional time, consumable disposals, patients’ transport and sick leaves. The model accounted the 5% wastage of IV-TRA administration. Unit costs were obtained utilizing official (Monetengrin Dug Agency (CALIMS) and clinic pharmacy) publicly available data and they were expressed in local currency (Euro) with discount aplied for SC-TRA.

RESULTS: Direct drug related costs per mean patient weight were up to 8,3 % savings for SC-TRA and up to 9,9% also for SC-TRA when indirect costs included. The results of the analysis were most sensitive to patient weight, daily hospital fee and % of wastage in IV treated patients. Mean savings (preparation and administration) in time with SC-TRA were 55 min.

CONCLUSIONS: SC-TRA is time and cost-saving therapy for HER2+ breast cancer patients in Montenegro.