another dispassionate, cold-hearted but hopeful(!) view of the cost of herceptin

[Lani]

ABSTRACT: ASCO 2007: #6534: Estimating the real cost of adjuvant (adj) trastuzumab (T) in patients (pts) with HER-2+ (H+) early stage breast cancer (ESBC): Potential impact of reduced use of expensive oncology drugs (EOD) in metastatic breast cancer (MBC) [American Society of Clinical Oncology]
Background: Pts with H+ early stage BC have an approximately 35% risk of developing MBC (BCIRG001). T has been reported to reduce this risk by 33-50%, but costs approximately €30k per pt, a burden some health systems deem unsustainable. This risk reduction might however result in decreased utilization of EOD in MBC, lowering the societal cost of adjT. We attempted to estimate the cost per relapse prevented (Crp), and the real cost of adjT, allowing for potential savings in prevented cases of MBC.
Methods: We conducted a retrospective analysis of the mean cost per pt of AdjT (1 year) and of EOD in MBC in St. Vincent's University Hospital. We devised an equation to calculate the Crp for adj T. Crp=[A-M(NRA/104)]/[NRA/104] where A = cost per pt for adjT, M = EOD cost per pt with MBC, N = % of pts relapsing after standard adj treatment, RA = % reduction in the risk of relapse after adjT (over standard adj).
Results: H+ pts with MBC received T (average 34 cycles €2,400 each) with a combination of the following drugs: docetaxel (x8 €1,500), gemcitabine (x5 €1,215), capecitabine (x8 €400), vinorelbine ( x19 €187). Only 2 pts received bevacizumab (Bev) (x15 €3,000). In our unit the mean EOD cost per pt with MBC was €108k. The cost per relapse prevented for a 33% and a 50% reduction in relapse rate would be €152k and €63k, respectively. Furthermore, assuming a 50% reduction in the rate of relapse (from 35 to 17.5%) the real cost of adjT per pt treated is not €30k, but approximates €11k (€30k x 100-{17.5x €108k}).
Conclusions: The reduced utilization of EOD in MBC likely has a very beneficial impact on the societal cost of adjT. Confirmation of the efficacy of shorter adjT (e.g. FinnHer) would produce further benefit. The increasing use of novel EOD in MBC e.g. Bev would make adjT even more cost-effective.