Background Pertuzumab is indicated for Her2-positive breast cancer (BC) in combination with trastuzumab and chemotherapy.
Purpose To describe pertuzumab utilisation as Her2-positive BC treatment at an oncology reference hospital and to analyse treatment-associated costs according to its different indications.
Material and methods We designed an observational retrospective study of drug utilisation. All Her2-positive BC patients treated with pertuzumab from its EMA authorisation until August 2017 were included. Data collected from patients’ medical history records were age, cancer stage and lines of treatment. The number of administered doses, daily dose and combined drugs for each patient were collected from an oncology-assisted prescribing computer application. Pertuzumab cost for each patient was calculated. Frequency, mean and standard deviation (s) were calculated.
Results Fifty patients were treated with a mean age of 51.2 years (27–77). Sixteen patients (32%) were treated for metastatic disease (MD) and 34 (68%) were early-staged patients with a neoadjuvant therapy (NAT). All patients received trastuzumab. Within the MD group (n=16), 15 patients received pertuzumab as a first-line therapy. One patient had received multiple prior lines of treatment before pertuzumab. The triplet pertuzumab +tratuzumab + chemotherapy was the regime chosen for this group. Pertuzumab mean dose per cycle was 481 mg, with a mean of 13.6 cycles administered to each patient.
Within the NAT group (n=34), the schedule used, before surgery, was a sequenced regime consisting of, first, four cycles of dose-dense epirubicine-cyclophosphamide, followed by four cycles of pertuzumab +trastuzumab + chemotherapy triplet. Pertuzumab mean dose in this group was 545 mg, with a mean of 3.68 cycles per patient.
Pertuzumab occasioned an incremental cost of €8 95 212 (€531,174 MD treatment, €3 64 038 neoadjuvant treatment) above standard treatment cost before pertuzumab authorisation by regulatory agencies. Pertuzumab mean incremental cost per patient in MD treatment was €33 198 (s=29,069) (6.868–107.608) and €10 707 (s=1.757) (4. 579–13. 737) in the case of NAT.
Conclusion There is a major number of neoadjuvant treatments including pertuzumab in comparison with MD treatments, even though neoadjuvant indication approval came later. However, treatment costs associated with NAT are significantly lower, as the duration of this treatment is shorter than MD. Incremental cost associated with pertuzumab has meant a significant rise in total expenditure for the treatment of metastatic Her2-positive BC.
No conflict of interest
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