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A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy

INTRODUCTION: Clinical trials confirmed the beneficial effects of adding pertuzumab (P) to the combination of trastuzumab-chemotherapy (TC) in the (neo)adjuvant setting of high-risk HER2-positive early breast cancer (HER2+BC). We evaluated the clinical, economic and societal impact of adding pertuzu...

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Autores principales: Zambelli, Alberto, Cazzaniga, Marina, La Verde, Nicla, Munzone, Elisabetta, Antonazzo, Ippazio Cosimo, Mantovani, Lorenzo Giovanni, Di Cosimo, Serena, Mancuso, Anna, Generali, Daniele, Cortesi, Paolo Angelo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10428118/
https://www.ncbi.nlm.nih.gov/pubmed/37573652
http://dx.doi.org/10.1016/j.breast.2023.08.005
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author Zambelli, Alberto
Cazzaniga, Marina
La Verde, Nicla
Munzone, Elisabetta
Antonazzo, Ippazio Cosimo
Mantovani, Lorenzo Giovanni
Di Cosimo, Serena
Mancuso, Anna
Generali, Daniele
Cortesi, Paolo Angelo
author_facet Zambelli, Alberto
Cazzaniga, Marina
La Verde, Nicla
Munzone, Elisabetta
Antonazzo, Ippazio Cosimo
Mantovani, Lorenzo Giovanni
Di Cosimo, Serena
Mancuso, Anna
Generali, Daniele
Cortesi, Paolo Angelo
author_sort Zambelli, Alberto
collection PubMed
description INTRODUCTION: Clinical trials confirmed the beneficial effects of adding pertuzumab (P) to the combination of trastuzumab-chemotherapy (TC) in the (neo)adjuvant setting of high-risk HER2-positive early breast cancer (HER2+BC). We evaluated the clinical, economic and societal impact of adding pertuzumab to neoadjuvant TC combination (TPC) in Italy. METHODS: A cost-consequence analysis comparing TPC vs. TC was performed developing a cohort-based multi-state Markov model to estimate the clinical, societal and economic impact of the neoadjuvant therapy of TPC versus TC in HER2+BC at high-risk of recurrence. The model works on a cycle length of 1 month and 5-years-time horizon. Literature review-based data were used to populate the model. The following clinical and economic outcomes were estimated: cumulative incidence of loco-regional/distant recurrences, life of years and QALY and both direct and indirect costs (€). Finally, sensitivity analyses were performed. RESULTS: TPC was associated with a 75,630 € saved of direct costs. Specifically, it was associated with an initial increase of treatment costs (+4.8%) followed by reduction of recurrence management cost (−20.4%). TPC was also associated with an indirect cost reduction of 1.40%, as well as decreased incidence of distant recurrence (−20.14%), days of work lost (−1.53%) and days lived with disability (−0.50%). Furthermore, TPC reported 10,47 QALY gained (+2.77%) compared to TC. The probability to achieve the pathological complete response (pCR) was the parameter that mostly affected the results in the sensitivity analysis. CONCLUSION: Our findings suggested that TPC combination could be a cost-saving option in patients with HER2+BC at high-risk of recurrence.
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spelling pubmed-104281182023-08-17 A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy Zambelli, Alberto Cazzaniga, Marina La Verde, Nicla Munzone, Elisabetta Antonazzo, Ippazio Cosimo Mantovani, Lorenzo Giovanni Di Cosimo, Serena Mancuso, Anna Generali, Daniele Cortesi, Paolo Angelo Breast Original Article INTRODUCTION: Clinical trials confirmed the beneficial effects of adding pertuzumab (P) to the combination of trastuzumab-chemotherapy (TC) in the (neo)adjuvant setting of high-risk HER2-positive early breast cancer (HER2+BC). We evaluated the clinical, economic and societal impact of adding pertuzumab to neoadjuvant TC combination (TPC) in Italy. METHODS: A cost-consequence analysis comparing TPC vs. TC was performed developing a cohort-based multi-state Markov model to estimate the clinical, societal and economic impact of the neoadjuvant therapy of TPC versus TC in HER2+BC at high-risk of recurrence. The model works on a cycle length of 1 month and 5-years-time horizon. Literature review-based data were used to populate the model. The following clinical and economic outcomes were estimated: cumulative incidence of loco-regional/distant recurrences, life of years and QALY and both direct and indirect costs (€). Finally, sensitivity analyses were performed. RESULTS: TPC was associated with a 75,630 € saved of direct costs. Specifically, it was associated with an initial increase of treatment costs (+4.8%) followed by reduction of recurrence management cost (−20.4%). TPC was also associated with an indirect cost reduction of 1.40%, as well as decreased incidence of distant recurrence (−20.14%), days of work lost (−1.53%) and days lived with disability (−0.50%). Furthermore, TPC reported 10,47 QALY gained (+2.77%) compared to TC. The probability to achieve the pathological complete response (pCR) was the parameter that mostly affected the results in the sensitivity analysis. CONCLUSION: Our findings suggested that TPC combination could be a cost-saving option in patients with HER2+BC at high-risk of recurrence. Elsevier 2023-08-08 /pmc/articles/PMC10428118/ /pubmed/37573652 http://dx.doi.org/10.1016/j.breast.2023.08.005 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Article
Zambelli, Alberto
Cazzaniga, Marina
La Verde, Nicla
Munzone, Elisabetta
Antonazzo, Ippazio Cosimo
Mantovani, Lorenzo Giovanni
Di Cosimo, Serena
Mancuso, Anna
Generali, Daniele
Cortesi, Paolo Angelo
A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title_full A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title_fullStr A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title_full_unstemmed A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title_short A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy
title_sort cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in her2-positive high-risk early breast cancer in italy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10428118/
https://www.ncbi.nlm.nih.gov/pubmed/37573652
http://dx.doi.org/10.1016/j.breast.2023.08.005
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