TITLE:
Economic Analysis of Intravenous vs. Subcutaneously Administered Trastuzumab for the Treatment of HER2+ Early Breast Cancer in Malaysia
AUTHORS:
Wei Ching Lee, Mohd Roslan Haron, Kong Leong Yu, Flora Li Tze Chong, Adrian Goh, Soraya Azmi
KEYWORDS:
Cost-Minimisation Analysis, Trastuzumab, Subcutaneous, Intravenous, Breast Cancer, Malaysia
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.5 No.1,
January
11,
2016
ABSTRACT: Human epidermal growth factor receptor-2 over expression
has been reported in 23% - 37.3% of Malaysian breast cancer patients.
Trastuzumab is a recommended adjuvant therapy for
patients with early breast cancer. Currently, trastuzumab is administered
intravenously but a new subcutaneous formulation could save time and costs. In
Malaysia, the Ministry of Health funds most of the costs of secondary care,
including cancer treatment. We performed a cost-minimisation analysis from the
Ministry of Health and societal perspectives by adapting an excel-based
mathematical model. Model inputs comprised of drug, consumables and personnel
costs. Data sources were government statistics, price lists, government salary
scales and estimated personnel time costs. Doctors, nurses and pharmacists at
four hospitals estimated the time to perform necessary tasks following their
usual practice. Results showed that subcutaneous trastuzumab could, on average,
save an estimated 43.5 minutes of pharmacists’ time and 11.6 minutes and 4.9
minutes of nurses’ time administering loading dose and subsequent doses,
respectively. Total cost savings were RM7561 (8.7%) per patient per year,
consisting of RM6496 (7.6%) reduction in drug cost and RM1065 (66.2%) reduction
in non-drug costs. Similarly, cost savings from the societal perspective were
RM7820 per patient per year, comprising RM6496 (7.6%) and RM1325 (63.7%) of
drug and non-drug costs savings, respectively. Sensitivity analyses showed that
cost savings on subcutaneous formulation ranged from RM3715 to RM11408 to the
Ministry of Health. Overall, subcutaneous trastuzumab is estimated to be
cost-saving from Ministry of Health and societal perspectives. Other benefits
from saving patients’ and carers’ time and convenience could not be taken into
account. This study was a first to investigate cost-savings from subcutaneous
trastuzumab in a middle-income Asian country and the findings were consistent
with findings of earlier studies. Given the favourable impact on time and
costs, subcutaneous trastuzumab should be considered a viable option for
Malaysian patients.