Cost-effectiveness of pertuzumab and trastuzumab biosimilar combination therapy as initial treatment for HER2-positive metastatic breast cancer in Singapore

ABSTRACT

Background

This study evaluates the cost-effectiveness of pertuzumab with trastuzumab biosimilar and docetaxel as initial treatment for HER2-positive metastatic breast cancer (MBC) in Singapore.

Methods

A partitioned survival model with three health states was developed to evaluate the cost-effectiveness of trastuzumab biosimilar and docetaxel with or without pertuzumab from a healthcare system perspective over a 15-year time horizon for patients with HER2-positive MBC. Key clinical inputs were derived from the CLEOPATRA trial. Health state utilities were derived from the literature and direct medical costs were obtained from local public healthcare institutions.

Results

The base-case resulted in an incremental cost-effectiveness ratio (ICER) of SGD366,658 (USD272,244) per quality-adjusted life-year (QALY) gained. One-way sensitivity analyses showed that the ICER was sensitive to utilities in the progression-free state, price of pertuzumab and time horizon. When the price for trastuzumab reference biologic (branded) was applied, the ICER was even higher (SGD426,996 [USD317,045]/QALY).

Conclusion

Although trastuzumab biosimilar reduced the cost of the pertuzumab combination regimen, the ICER remained high and was not cost effective in Singapore’s context. As pertuzumab contributed 80% of the overall combination treatment cost, price reductions for pertuzumab will be required to improve the cost-effectiveness of combination treatment to an acceptable level.

KEYWORDS:

• Breast cancer
• human epidermal growth factor receptor 2
• pertuzumab
• partitioned survival analysis
• cost-effectiveness analysis
• combination therapy

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

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

Author contributions

LJC developed the economic model, performed the analyses, collected and reviewed the data, interpreted the results, drafted and revised the manuscript. LL collected and reviewed the data, interpreted the results, drafted and revised the manuscript. ESL provided clinical input and validated model assumptions. MIAZ contributed to the development of the economic model, interpretation of the results and revised the manuscript. FP and KN contributed to the interpretation of the results and revised the manuscript. All authors read and approved the final manuscript.

Acknowledgments

No assistance in the preparation of this article is to be declared.

Data availability statement

All data generated or analysed during this study are included in this published article or in the supplementary material of this article.

Ethics approval and consent to participate

Not applicable, the study did not involve human subjects.

Additional information

Funding

This paper was not funded.