Cost minimization analysis of treatments for metastatic HER2-positive breast cancer in Peru: Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injections

PLoS One. 2024 Nov 11;19(11):e0295730. doi: 10.1371/journal.pone.0295730. eCollection 2024.

Abstract

The main objective of this study is to determine whether the employment of fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC; and Phesgo as brand name) to treat metastatic HER2-positive breast cancer patients would minimize costs compared to the traditional treatment of separate intravenous doses of pertuzumab and trastuzumab in Peru. To achieve this, we used EsSalud (the social security health insurance) data and assessed it through a mixed strategy, which consisted of a quantitative and a qualitative approach. The first one aimed to calculate the direct (non-drug consumables, drugs, and healthcare professionals) and indirect costs of both treatments to develop a comparison, whilst the second aimed to validate information and internalize the procedure in an EsSalud context. Overall, we found that the usage of PH FDC SC would be cost saving in EsSalud's context. Specifically, we found three main advantages. Firstly, PH FDC SC generates a savings of 62% in non-drug consumables, which helps alleviate the healthcare system budget constraint. Secondly, its adoption frees up 61 hours of treatment and observation time for a single patient per year, which in turn increases the attention capacity of the healthcare system in terms of nursing hours and chemotherapy couches. Thirdly, the reduction of clinic time supposes an advantage for the patient in the form of increased productivity and well-being. Hence, the adoption of this drug would improve the quality of life of patients while reducing costs and pressure on the healthcare system. This is aligned with the strategy of prioritizing the appropriate breast cancer treatment within the National Cancer Care Plan. In this regard, we also found that the savings produced from switching from the traditional intravenous treatment to the subcutaneous one would allow EsSalud to afford full annual costs of 2 additional treatments, but without increasing their budget. This would cover 7% of the gap of 29 patients who do not have access to full treatment.

MeSH terms

  • Antibodies, Monoclonal, Humanized* / administration & dosage
  • Antibodies, Monoclonal, Humanized* / economics
  • Antibodies, Monoclonal, Humanized* / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / economics
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / economics
  • Breast Neoplasms* / pathology
  • Female
  • Humans
  • Injections, Subcutaneous
  • Neoplasm Metastasis
  • Peru
  • Receptor, ErbB-2* / metabolism
  • Trastuzumab* / administration & dosage
  • Trastuzumab* / economics
  • Trastuzumab* / therapeutic use

Substances

  • Trastuzumab
  • pertuzumab
  • Antibodies, Monoclonal, Humanized
  • Receptor, ErbB-2
  • ERBB2 protein, human

Grants and funding

This study was funded by Roche Peru (https://www.roche.com.pe/) through consulting fees provided to APOYO Consultoría, a company where Miguel Figallo and Mauricio Gonzalez are currently employed. Both Maria Fernanda Delgado and Adrián Arenas were also employed by APOYO Consultoría during the study's development, and their participation was likewise supported by this funding. However, this funding did not increase the salary of the researchers. In addition, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funding from Roche Peru solely contributed to the financial support necessary for conducting the study and for paying publication fees. No additional external funding was received for this study.