OBJECTIVES:

Breast cancer (BC) is the most common cancer in women. In 2015 5480 new cases were noted in Austria; it is estimated that 90.5% are operable early-breast-cancer (eBC) and approximately 18% over-express HER2. HER2 positivity is associated with more aggressive disease, higher recurrence-rate, and increased mortality. Trastuzumab is a monoclonal antibody targeting the HER2 receptor, considered standard-of-care (SOC) for the treatment of HER2+ BC. The APHINITY trial has demonstrated that adding another HER2-targeted antibody, Pertuzumab, improved eBC outcomes compared to SOC.

The aim is to determine the budgetary-impact of implementing the APHINITY-regimen in the Austrian setting (adding Pertuzumab to current adjuvant SOC) Three scenarios are evaluated: treating all HER2+ eBC patients (APHINITY ITT), or one subgroup (node positive, LN+, or hormone receptor negative, HR-).

METHODS:

A multi-cohort, HER2+ population-based model was developed, which includes two model parts (eBC, mBC) with the following states: (a) eBC (disease-free-survival, recurrence, death) and (b) mBC (disease-free-survival, progressive disease, death). Results show the budget-impact over 5 years (including drug costs, monitoring costs, adverse-event costs, costs of recurrence (mBC) and end-of-life costs) for the different risk-groups from the payer’s perspective.

RESULTS:

For the entire HER2+ population (ITT, n=886) the APHINITY scheme leads to a positive budget-impact of 62.4 million€ (12.5 million€/year or 3.8% of total hospital medication expenditures). The associated clinical-benefit amounts to 1.7% (iDFS benefit). For treatment of LN+ patients only (n=380) the budget-impact amounts to 20.9 million€ (4.2 million€/year or 1.3% of total hospital medication expenditures) with an associated clinical-benefit of 3.2%. Treating only HR- patients (n=376) results in a budget-impact of 19.4 million€ (3.9 million€/year or 1.2% of total hospital medication expenditures) and an associated clinical-benefit of 2.3%.

CONCLUSIONS:

Adding adjuvant Pertuzumab would reduce disease-burden with affordable additional expenses.