OBJECTIVES: Trastuzumab is targeted to HER2 (human epidermal growth factor receptor 2) and is indicated for the treatment of HER2-positive early and metastatic breast cancer and metastatic gastric cancer. Trastuzumab was delivered by the intravenous (TIV) route, although a recently subcutaneous formulation has been developed. Subcutaneous administration of monoclonal antibodies can offer substantial patient and resource benefits compared with IV formulation. Trastuzumab SC (TSC) has demonstrated substantially shorter administration times and comparable tolerability and pharmacokinetics compared with TIV. The aim was to assess the hospital budget impact of only TSC against TIV+TSC for breast cancer patients.

METHODS: A budget Impact analysis was carried out based on real world data from a hospital center (from April 2017 to March 2018). All patients had breast cancer HER2-positive and was treated with TIV or TSC based on medical criteria. The budget impact model compared current market (pool TIV + TSC) against hypothetical scenario (only TSC). Data sourceS were electronic medical records, data claims and costs from Denia Hospital. All costs were €2018 and included direct cost (drugs, clinicians and materials) and indirect cost (patient and caregiver). We have performed a sensitivity analysis to validate the robustness of results.

RESULTS: Current scenarios included 58 patients eligible (38 TIV and 20 TSC) with an average of 5.0 (SD: 3.2) cycles per patients. TIV patients needed more cycles than TSC patients (5.8 ±3.6 TIV vs 3.4±1.4 TSC). Direct cost was higher for the current scenario (€71.553). Current scenario showed a total cost of €466.480 and hypothetical scenario showed €393.654. The most sensible parameter was drug cost. Two scenarios would be equivalent, only if TIV drug cost was €410.84.

CONCLUSIONS: Hypothetical scenario (only TSC) showed savings for the hospital perspective. Change all patients to TSC is efficient for pharmacological management.