Cost-effectiveness analysis of neoadjuvant pertuzumab and trastuzumab therapy for locally advanced, inflammatory, or early HER2-positive breast cancer in Canada

Abstract

Objective:

The NeoSphere trial demonstrated that the addition of pertuzumab to trastuzumab and docetaxel for the neoadjuvant treatment of HER2-positive locally advanced, inflammatory, or early breast cancer (eBC) resulted in a significant improvement in pathological complete response (pCR). Furthermore, the TRYPHAENA trial supported the benefit of neoadjuvant dual anti-HER2 therapy. Survival data from these trials is not yet available; however, other studies have demonstrated a correlation between pCR and improved event-free survival (EFS) and overall survival (OS) in this patient population. This study represents the first Canadian cost-effectiveness analysis of pertuzumab in the neoadjuvant treatment of HER2-positive eBC.

Methods:

A cost-utility analysis (CUA) was conducted using a three health state Markov model (‘event-free’, ‘relapsed’, and ‘dead’). Two separate analyses were conducted; the first considering total pCR (ypT0/is ypN0) data from NeoSphere, and the second from TRYPHAENA. Published EFS and OS data partitioned for patients achieving/not achieving pCR were used in combination with the percentage achieving pCR in the pertuzumab trials to estimate survival. This CUA included published utility values and direct medical costs including drugs, treatment administration, management of adverse events, supportive care, and subsequent therapy. To address uncertainty, a probabilistic sensitivity analysis (PSA) and alternative scenarios were explored.

Results:

Both analyses suggested that the addition of pertuzumab resulted in increased life-years and quality-adjusted life-years (QALYs). The incremental cost per QALY ranged from $25,388 (CAD; NeoSphere analysis) to $46,196 (TRYPHAENA analysis). Sensitivity analyses further support the use of pertuzumab, with cost-effectiveness ratios ranging from $9230–$64,421. At a threshold of $100,000, the addition of pertuzumab was cost-effective in nearly all scenarios (93% NeoSphere; 79% TRYPHAENA).

Conclusion:

Given the improvement in clinical efficacy and a favorable cost per QALY, the addition of pertuzumab in the neoadjuvant setting represents an attractive treatment option for HER2-positive eBC patients.

Keywords::

• Cost-effectiveness analysis
• Cost-utility analysis
• Pertuzumab
• Trastuzumab
• Neoadjuvant
• HER2-positive
• Breast cancer

Transparency

Declaration of funding

The work reported in this manuscript was funded via a consultancy agreement between Cornerstone Research Group, Inc. and Hoffmann–La Roche Ltd. Canada.

Declaration of financial/other relationships

CLA, ANP, STB, and MFT disclose that they are consultants commissioned by Hoffmann–La Roche Ltd. Canada to perform this study. SY and POT disclose that they are employees of Hoffmann–La Roche Ltd. SD, AHP, and GAW have received honoraria for participating in consultant meetings for Hoffmann–La Roche Ltd. Canada. The final manuscript has been read and approved by all authors. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge Dr Jean-Francois Boileau for his clinical advice and assistance with model design and parameterization. The authors would also like to acknowledge Vanja Petrovic and Douglas Millar for their careful review of the manuscript. Work by all contributing non-authors was funded by Hoffmann–La Roche Ltd. Canada.

Notes

*Herceptin is a registered tradename of Genentech Inc, San Francisco, California, US.

†Perjeta is a registered tradename of Hoffmann-La Roche AG, in Basel, Switzerland.