Pharmacoeconomics of novel pharmacotherapies in triple-negative breast cancer

ABSTRACT

Introduction

Triple-negative breast cancer (TNBC) represents the most aggressive breast cancer subtype carrying unfavorable clinical outcomes. Although traditionally chemotherapy has represented the only systemic treatment option available, novel drugs have changed the treatment landscape, granting approval by regulatory agencies worldwide, while determining new economic struggles on health systems for their high prices.

Areas covered

In this review, we provided a comprehensive analysis of pharmacoeconomic studies of drugs recently approved in the early and advanced settings of TNBC.

Expert opinion

Novel systemic treatment options redefined the therapeutic algorithms for TNBC by establishing new paradigms, based on substantial clinical benefits. Pembrolizumab and olaparib in the curative setting portend high value, as shown with the use of value frameworks, resulting in cost-effective interventions. In the metastatic setting, new drugs have demonstrated mixed improvements in patient-centric end-points, resulting often in interventions unlikely to have good value for money. We believe that cost-effectiveness alone is not a metric to inform the opportunity to invest on new interventions, while the intrinsic value of medicines should be the driver of the decisions. We endorse a patient-centric priority setting that can ensure health system sustainability, to timely deliver innovative cancer care to all in need and positively impact on population health.

KEYWORDS:

• Antibody–drug conjugates
• breast cancer
• cost-effectiveness
• cost–utility
• immunotherapy
• PARP inhibitors
• pharmacoeconomics
• triple-negative breast cancer

Article highlights

• Delivering health for all in oncology is a question of cost-effectiveness and should be put in the context of value, budget impact, sustainability, and population health benefits.

• Novel treatment options have been approved for TNBC in early and advanced diseases.

• Novel drugs can lead to economic struggles for health systems due to their high prices.

• Cost-effectiveness of new cancer drugs for TNBC has been reported in the curative setting but not always for metastatic treatments.

• Value-based considerations should drive decision-making, including price-negotiations, based on patient-centric value frameworks like the ESMO-MCBS.

Declaration of interest

G Curigliano received honoraria for speaker, consultancy, or advisory rule from AstraZeneca, Roche, Pfizer, Novartis, Seattle Genetics, Lilly, Ellipses Pharma, Foundation Medicine, Daiichi Sankyo, and Samsung; all are to be intended outside the present work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization: all authors; Methodology: all authors; Supervision: D Trapani, G Curigliano; Roles/Writing – original draft: all authors; Writing – review & editing: all authors.

Additional information

Funding

This paper was not funded.