Economic Analysis of Intravenous vs. Subcutaneously Administered Trastuzumab for the Treatment of HER2+ Early Breast Cancer in Malaysia

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 * Corresponding author. W. C. Lee et al.2 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.

Impact of the subcutaneous formulations of trastuzumab and rituximab on efficiency and resource optimization in Spanish hospitals: H-Excelencia study

“…First, the estimations of treatment and preparation time data by HCPs were obtained directly from the interviews, without being verified through direct observation, and could therefore be a source of recall bias. Nevertheless, since the estimated reduction in administration times observed in our study are consistent with those reported in similar studies in other countries [ 24 , 25 ], we can conclude this limitation is unlikely to have significantly influenced our study results. Our study included 10 hospitals from evenly distributed geographic sites across Spain, and although they were of different sizes, and included both public and private institutions, our results would likely have varied if hospitals different to these had been included in the study.…”

“…Real-world studies have also consistently reported reductions in resource utilization and costs associated with conversion from IV to SC administration of rituximab and trastuzumab [ 12 , 14 , 15 , 17 , 24 , 25 ]. While these studies had similar conclusions, the magnitude of the estimated savings differed between studies.…”

“…As described, most studies have used an observational methodology, but very few have been based on direct interviews with HCPs like the current study [ 24 , 25 ]. Despite these studies being performed in different countries (Denmark [ 24 ] and Malaysia [ 25 ]), the HCP estimates of cost savings achieved with conversion from IV to SC trastuzumab formulation are quite consistent across these different sites.…”

From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review

“…These analyses were published between 2007 and 2017. For example, a costminimization analysis was conducted to determine the average cost of different routes of administration for trastuzumab in HER21 breast cancer, 39 and a budget impact analysis was done to determine the financial implication of peritoneal dialysis. 40 It was reported that 55% of the studies were conducted using the healthcare provider perspective, 29% adopted a societal perspective, and 13% reported mean costs based on both perspectives.…”

Bone Targeting Agents in Prevention of Skeletal-Related Events in Metastatic Cancers of Solid Tumours: An Economic Evaluation

“…The costs used in this analysis were based on MOH Consumer Price Guide from Pharmaceutical Services Program (2018), Malaysian DRG Casemix costing (severity illness 2), MOH Investigation Charges from website (2018), published literature using local data (Lee WC et al, 2016, Zainal R et al, 2014, Dranitsaris G et al, 2011, Hwa YS et al, 2011 and personal communication with pharmacists from National Cancer Institute, Malaysia. Direct medical costs included were cost of drugs, cost of procedures such as IV and subcutaneous administration of drugs, cost of investigations such as renal profile, cost of SRE related management (pathological fracture, radiotherapy to the bone and spinal cord compression requiring instrumentation), cost of specialist clinic follow-ups and palliative care.…”