Economic evaluation of trastuzumab in HER2-positive early breast cancer in Indonesia: A cost-effectiveness analysis

• Published in: PloS one Vol. 19; no. 5; p. e0304483
• Main Authors: Khoirunnisa, Sudewi Mukaromah, Suryanegara, Fithria Dyah Ayu, Setiawan, Didik, Postma, Maarten Jacobus, de Jong, Lisa Aniek
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.05.2024; Public Library of Science (PLoS)
• Subjects: Adult; Age; Age groups; Aged; Antineoplastic Agents, Immunological - economics; Antineoplastic Agents, Immunological - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - economics; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Cancer; Cancer therapies; Chemotherapy; Clinical trials; Comparative analysis; Cost analysis; Cost benefit analysis; Cost control; Cost-Effectiveness Analysis; Decision making; Diagnosis; Disease management; Economic aspects; Effectiveness; Epidermal growth factor; ErbB-2 protein; Female; GDP; Gross Domestic Product; Growth factors; Health aspects; Humans; Indonesia; Markov Chains; Markov processes; Medical care, Cost of; Medical diagnosis; Medical prognosis; Metastasis; Middle Aged; Monoclonal antibodies; Mortality; Parameter sensitivity; Parameter uncertainty; Patients; Prognosis; Quality-Adjusted Life Years; Receptor, ErbB-2 - metabolism; Sensitivity analysis; Social security; Subgroups; Targeted cancer therapy; Trastuzumab; Trastuzumab - economics; Trastuzumab - therapeutic use; Indonesia; Asia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0304483

Trastuzumab has significantly enhanced the survival and prognosis of individuals diagnosed with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. Considering its relatively high costs, we aimed to examine the cost-effectiveness of trastuzumab plus chemotherapy compared with chemotherapy alone in HER2-positive early breast cancer from an Indonesian healthcare payer's perspective. A Markov model was developed to project the lifetime health benefits and costs associated with trastuzumab treatment for a cohort of women with HER2-positive early breast cancer. Efficacy data and baseline characteristics in the base-case analysis were primarily derived from the 11-year results of the HERA trial. Costs were based on verified reimbursement data from Indonesia's Health and Social Security Agency (BPJS Kesehatan) of the year 2020. A scenario analysis was conducted with efficacy data based on the joint analysis from the NSABP B-31 and NCCTG N9831 trials, allowing for subgroup analysis by age at diagnosis. Univariate and probabilistic sensitivity analyses were conducted to assess the influence of parameter uncertainty. In the base-case analysis, the results indicated that the lifetime costs for trastuzumab plus chemotherapy and chemotherapy alone were US$33,744 and US$22,720, respectively, resulting in substantial incremental savings of US$11,024 per patient for the former. Trastuzumab plus chemotherapy also led to higher total quality-adjusted life years (QALYs) and life years gained (LYG), resulting in incremental cost-effectiveness ratios (ICERs) of US$6,842 per QALY and US$5,510 per LYG. In scenario analysis, the subgroup with an age at diagnosis <40 years old reflected the most cost-effective subgroup. Both the base-case and scenario analyses demonstrated cost-effectiveness with a willingness-to-pay threshold of three-times Gross Domestic Product (GDP). Sensitivity analyses confirmed the robustness of the findings and conclusions. In Indonesia, trastuzumab plus chemotherapy can be considered cost-effective compared to chemotherapy alone at a willingness-to-pay threshold of three times GDP, and it is likely most cost-effective in women <40 years of age.