Does Trastuzumab Offer Good Value for Money for Breast Cancer Patients with Metastasis in Indonesia?

Abstract

Objective: Breast cancer is the most common cancer in Indonesia, with Indonesia's breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia. Methods:We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost-utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs). Result: From a healthcare provider's perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million. Conclusion: In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not costeffective in terms of PFS and OS compared with chemotherapy alone.

Validating the rigour of adaptive methods of economic evaluation

“… 44 The Indonesian study was excluded from the adaptation exercise as it did not pass through two of the critical objective criteria, and hence received a transferability score of 0. 45 Most of the studies had either used a healthcare system or payer perspective, while the EE from Thailand used a societal perspective. 40 The Philippines’ study had undertaken analysis both from a societal as well as a healthcare system perspective.…”

“…Trastuzumab A total of 11 EEs were identified for trastuzumab (table 1). [35][36][37][38][39][40][41][42][43][44][45] Of these, seven were undertaken in middle-income countries, 35 37 38 40 42 43 45 three were from high-income countries, 36 39 41 while the remaining one study was a multicentre evaluation conducted for seven Latin-American countries. 44 The Indonesian study was excluded from the adaptation exercise as it did not pass through two of the critical objective criteria, and hence received a transferability score of 0.…”