Assessing the fiscal consequences of novel and existing treatments for triple negative breast cancer in Switzerland by applying a government perspective framework

Figures & data

Table 1. Summary of key CE-model assumptions.

Assumption	Value/description	Source
Starting age	49 years of age	KEYNOTE-522^28
Cycle length	1 week	Favre‑Bulle et al.^26
Time horizon	Lifetime horizon (51 years based on starting age)	Favre‑Bulle et al.^26
Intervention	Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab	KEYNOTE-522^28
Comparator	Neoadjuvant chemotherapy followed by adjuvant placebo	KEYNOTE-522^28
Data inputs	Clinical efficacy, safety, utility data	KEYNOTE-522^25^,^28

Table 2. Overview of fiscal effects.

Economic effect	Value (type)	Relevant health states	Source
Employment post-diagnosis	0.82 (RR)	EF/LR/DM	Noeres et al.^30
Economic activity (recurrence)	0.61 (HR)	LR/DM	Sieluk et al.^16
Long-term disability (recurrence)	2.48 (HR)	LR/DM	Sieluk et al.^16
Sick leave (EF)	1.91 (OR)	EF	Lundh et al.^15
Sick leave (recurrence)	2.13 (HR)	LR/DM	Sieluk et al.^16

Abbreviations. DF, fisease free; DM, distant metastasis; EF, event free; HR, hazard ratio; LR, locoregional recurrence; OR, odd ratios; RR, relative risk.

Table 3. Present value of expected tax revenue and healthcare costs with incremental results (CHF).

Fiscal effect	Average population	P + C→P	Chemotherapy
Tax on income (direct and indirect)	296,570	193,812	164,079
Tax on social benefits	7,745	13,495	11,237
Total tax revenue	304,315	207,306	175,315
Excess healthcare costs	–	135,143	92,285
Incremental Fiscal Effects	P + C→P vs. Average population	Chemotherapy vs. Average population	P + C→P vs. Chemotherapy
Tax on income (direct and indirect)	−102,758	−132,491	29,733
Tax on social benefits	5,750	3,492	2,258
Total tax revenue	−97,008	−128,999	31,991
Excess healthcare costs	135,143	92,285	42,857

Abbreviations. P + C→P, Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab.

Table 4. Present value of expected social benefit expenditure (CHF) and expected life years.

Social expenditure type	Average population	P + C→P	Chemotherapy
Disability payments	68,168	41,414	29,483
Sick leave payments	8,154	9,222	7,446
Unemployment payments	24,185	118,987	96,071
Total social benefit payments	100,508	169,622	133,000
Undiscounted life years	50.93	30.32	23.07
Average social benefit payments per life year	1,973	5,594	5,765

Abbreviations. P + C→P, Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab.

Table 5. Results of sensitivity analyses (CHF).

Scenario analysis	Average population	P + C→P	Chemotherapy
Scenario #1 – inclusion of longevity and retirement effect
Total tax revenue	335,994	225,647	187,951
Effect on transfer costs
Retirement payments	−410,748	−237,043	−159,525
Total social benefit payments	−511,255	−406,665	−292,524
Average social benefit payments per life year	−10,038	−13,411	−12,679
Scenario #2 – inclusion of spouse effect^*
Total tax revenue	304,315	204,972	172,977
Results of Probabilistic Analysis (incremental)	P + C→P vs. Average population	Chemotherapy vs. Average population	P + C→P vs. Chemotherapy
Tax on income (direct and indirect)	−104,552	−132,491	28,267
Tax on social benefits	6,075	3,492	1,529
Total tax revenue	−98,477	−128,999	29,796
Excess healthcare costs	134,935	92,419	42,516

Abbreviations. P + C→P: Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab.

*Spouse effect includes income loss and increased rates of work absences, which only affects tax revenue.

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Data availability statement

This study utilizes data from publicly available sources. No proprietary data has been used in modeling work, and all sources have been referenced throughout this manuscript as appropriate. There is no individual patient-level data used in this work.