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ABSTRACT
Objectives
The Asian PEONY trial showed that add-on pertuzumab to trastuzumab and chemotherapy significantly improved pathological complete response in the neoadjuvant treatment of patients with human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC). This study evaluated the cost-effectiveness of pertuzumab as an add-on therapy to trastuzumab and chemotherapy for neoadjuvant treatment of patients with HER2+ EBC in Singapore.
Methods
A six-state Markov model was developed from the Singapore healthcare system perspective, with a lifetime time horizon. Model outputs were: costs; life-years (LYs); quality-adjusted LYs (QALYs); incremental cost-effectiveness ratios (ICERs). Sensitivity/scenario analyses explored model uncertainties.
Results
The base case projected the addition of pertuzumab to be associated with improved outcomes by 0.277 LYs and 0.271 QALYs, increased costs by S$1,387, and an ICER of S$5,121/QALY. The ICER was most sensitive to the pCR rate, and the probabilistic sensitivity analysis showed that add-on pertuzumab had an 81.3% probability of being cost-effective at a willingness-to-pay threshold of S$45,000/QALY gained.
Conclusions
This model demonstrated that the long-term clinical impact of early pertuzumab use, particularly the avoidance of metastatic disease and thus avoidance of higher costs and mortality rates, make neoadjuvant pertuzumab a cost-effective option in the management of patients with HER2+ breast cancer in Singapore.
Article highlights
The present cost-effectiveness study, based on the Phase III PEONY RCT, is the first analysis evaluating the cost-effectiveness of neoadjuvant pertuzumab as an add-on to trastuzumab in a dual HER2 blockade regimen for EBC in the Singapore setting.
The cost-effectiveness study was developed in line with the recommendations in the Singapore ACE’s reference case.
Assumptions used in the model were conservative and reflected clinical practice in Singapore as confirmed by clinical experts.
The base case projected the addition of pertuzumab to be associated with improved outcomes by 0.277 LYs and 0.271 QALYs, increased costs by S$1,387, and an ICER of S$5,121/QALY.
The ICER was most sensitive to the pCR rate, and the probabilistic sensitivity analysis showed that add-on pertuzumab had an 81.3% probability of being cost-effective at a willingness-to-pay threshold of S$45,000/QALY gained.
This model demonstrated that the long-term clinical impact of early pertuzumab use, particularly the avoidance of metastatic disease and thus avoidance of higher costs and mortality rates, make neoadjuvant pertuzumab a cost-effective option in the management of patients with HER2+ breast cancer in Singapore.
Declaration of interest
E Hsuen Lim declares being a Consultant/Advisor for Roche Singapore Pte Ltd; Novartis; DKSH; Eisai; Eli Lilly.
A Lim declares being a Consultant/Advisor for Roche Singapore Pte Ltd.
J Singh Khara declares being a Stock Shareholder at Roche Singapore Pte Ltd and an employee at Roche Singapore Pte Ltd.
J Cheong declares being a Stock Shareholder at Roche Singapore Pte Ltd and an employee at Roche Singapore Pte Ltd.
J Fong declares being a Stock Shareholder at Roche Singapore Pte Ltd and an employee at Roche Singapore Pte Ltd.
S Sivanesan declares being a Stock Shareholder at Roche Singapore Pte Ltd and an employee at Roche Singapore Pte Ltd.
M Griffiths declares being a Consultant/Advisor for Roche Singapore Pte Ltd.
E New declares being a Consultant/Advisor for Roche Singapore Pte Ltd.
S Chin Lee declares being a Consultant/Advisor for Pfizer; Eisai; ACT Genomics; Novartis; AstraZeneca; Eli Lilly; MSD; Roche Singapore Pte Ltd; Daiichi Sankyo. S Chin Lee also declares receiving Grant/Research from Pfizer; Eisai; Taiho; ACT Genomics; Bayer; Karyopharm; Epizyme; Adagene; Novartis; MSD. They are also on the Speakers Bureau at Pfizer; Eisai; ACT Genomics; Novartis; AstraZeneca; Eli Lilly; MSD; Roche Singapore Pte Ltd.
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.
Author contributions
Substantial contributions to study conception and design: E Hsuen Lim, A Lim, J Singh Khara, J Cheong, J Fong, S Sivanesan, M Griffiths, E New, S Chin Lee.
Substantial contributions to analysis and interpretation of the data: E Hsuen Lim, A Lim, J Singh Khara, J Cheong, J Fong, S Sivanesan, M Griffiths, E New, S Chin Lee.
Drafting the article or revising it critically for important intellectual content: E Hsuen Lim, A Lim, J Singh Khara, J Cheong, J Fong, S Sivanesan, M Griffiths, E New, S Chin Lee.
Final approval of the version of the article to be published: E Hsuen Lim, A Lim, J Singh Khara, J Cheong, J Fong, S Sivanesan, M Griffiths, E New, S Chin Lee.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.