OBJECTIVES: To estimate the budgetary impact of subcutaneous trastuzumab, compared with intravenous trastuzumab, in the Brazilian Private Healthcare System, to treat early (eBC) and metastatic (mBC) HER-2 positive breast cancer.

METHODS: Perspectives were: private healthcare system, big health maintenance organization (HMO) (431,656 beneficiaries), medium HMO (45,100 beneficiaries), and small HMO (7,589 beneficiaries). Data from National Regulatory Agency for Private Health Insurance and Plans was used to obtain number of patients. Incidence and survival data of breast cancer were applied to reach the population of HER-2 positive eBC and mBC patients eligible to trastuzumab. For eBC, treatment options were trastuzumab monotherapy, and trastuzumab plus paclitaxel or docetaxel, after adjuvant chemotherapy. For mBC, associations with docetaxel or paclitaxel were considered for first line and monotherapy for second. A survey was performed with 28 HMOs to map fees and sources used for reimbursement of drugs, materials and procedures. Resource use estimates were performed by a multidisciplinary team. Direct medical costs were included; drugs and material prices were obtained from published sources and fees from survey results. Time horizon was 5 years and market share considered the uptake of subcutaneous trastuzumab starting with 20% in the first year, increasing to 100% in the fifth year. A deterministic sensitivity analysis was conducted to analyze model robustness.

RESULTS: In 5 years, 31,589 breast cancer patients were estimated for the private healthcare system, 284 patients for big, 30 patients for medium, and 6 patients for small HMOs. The progressive uptake of subcutaneous trastuzumab, compared with intravenous, can save up to 948,2 mBRL, 14,3 mBRL, 1,5 mBRL and 0,2 mBRL, respectively. Materials and support procedures along with medical fees were the most sensitive parameters.

CONCLUSIONS: Compared with the intravenous administration, subcutaneous trastuzumab can save up to 948,2 mBRL costs on breast cancer treatment in the Private Healthcare System.