Download PDF
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(03): 321-332
DOI: 10.1055/a-1921-9336
GebFra Science
Original Article

Is the (Neo)adjuvant Therapy of Patients with Primary HER2-positive Breast Cancer Cost-Covering?

Process Cost Analysis of Neoadjuvant and Post-Neoadjuvant Systemic Therapy of Patients with Primary HER2-positive Breast Cancer Article in several languages: English | deutsch
Natalia Krawczyk
1   Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
,
Eugen Ruckhäberle
1   Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
,
Michael Patrick Lux
2   Kooperatives Brustzentrum Paderborn, Frauen- und Kinderklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Paderborn, Germany
,
Tanja Fehm
1   Klinik für Frauenheilkunde und Geburtshilfe der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
,
Michael Greiling
3   Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule – University of Applied Sciences – Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
,
Michael Osygus
3   Institut für Workflow-Management im Gesundheitswesen (IWiG), c/o Europäische Fachhochschule – University of Applied Sciences – Hochschule für Gesundheit, Soziales und Pädagogik, Rheine, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction HER2 positivity is one of the most important predictive factors in the treatment of breast cancer patients. Thanks to new targeted anti-HER2 drugs, the prognosis for HER2-positive breast cancer patients has been significantly improved, and the treatment can now be designed according to the risk situation and the response to treatment. At the same time, these innovative targeted anti-HER2 drugs are associated with high costs and require long and involved patient care.

Materials and Methods In this paper, we compare the treatment costs of three post-neoadjuvant treatment regimens (trastuzumab vs. trastuzumab/pertuzumab vs. T-DM1) in early stage HER2-positive breast cancer from the perspective of the oncological outpatient clinic of a certified breast center at a university hospital, and evaluate the cost coverage.

Results The highest costs in systemic therapy were the material costs. These were the highest for dual blockade with trastuzumab/pertuzumab, followed by T-DM1 and trastuzumab monotherapy. According to our study, all three of these post-neoadjuvant therapy variants achieve a positive contribution margin. While all three models have similar contribution margins, the treatment pathway with T-DM1 is associated with a 30% lower contribution margin.

Conclusions Although these model calculations are associated with limitations in view of the introduction of biosimilar antibodies, it can be shown that modern therapeutic approaches do not always have to be associated with lower profits.

Keywords

HER2-positive breast cancer - targeted therapy - (post-)neoadjuvant treatment - cost analysis - cost effectiveness - efficiency


Publication History

Received: 13 April 2022

Accepted after revision: 08 August 2022

Article published online:
30 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Ditsch N, Untch M, Kolberg-Liedtke C. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2020. Breast Care (Basel) 2020; 15: 294-309
    CrossrefPubMedSearch in Google Scholar
  • 2 Schneeweiss A, Bauerfeind I, Fehm T. et al. Therapy Algorithms for the Diagnosis and Treatment of Patients with Early and Advanced Breast Cancer. Breast Care (Basel) 2020; 15: 608-618
    CrossrefPubMedSearch in Google Scholar
  • 3 Robert Koch Institut, Zentrum für Krebsregisterdaten, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.. Krebs in Deutschland 2015/2016. 2019 Accessed August 18, 2022 at: https://edoc.rki.de/bitstream/handle/176904/6012.3/krebs_in_deutschland_2019_2.pdf?sequence=6&isAllowed=y
    PubMedSearch in Google Scholar
  • 4 Malvezzi M, Carioli G, Bertuccio P. et al. European cancer mortality predictions for the year 2019 with focus on breast cancer. Ann Oncol 2019; 30: 781-787
    CrossrefPubMedSearch in Google Scholar
  • 5 Kümler I, Tuxen MK, Nielsen DL. A systematic review of dual targeting in HER2-positive breast cancer. Cancer Treat Rev 2014; 40: 259-270
    CrossrefPubMedSearch in Google Scholar
  • 6 Loibl S, Gianni L. HER2-positive breast cancer. Lancet 2017; 389: 2415-2429
    CrossrefPubMedSearch in Google Scholar
  • 7 von Minckwitz G, Procter M, de Azambuja E. et al. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer. N Engl J Med 2017; 377: 122-131
    CrossrefPubMedSearch in Google Scholar
  • 8 von Minckwitz G, Huang CS, Mano MS. et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med 2019; 380: 617-628
    CrossrefPubMedSearch in Google Scholar
  • 9 Pusztai L, Foldi J, Dhawan A. et al. Changing frameworks in treatment sequencing of triple-negative and HER2-positive, early-stage breast cancers. Lancet Oncol 2019; 20: e390-e396
    CrossrefPubMedSearch in Google Scholar
  • 10 Cortazar P, Zhang L, Untch M. et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 2014; 384: 164-172
    CrossrefPubMedSearch in Google Scholar
  • 11 Piccart M, Procter M, Fumagalli D. et al. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer in the APHINITY Trial: 6 Years’ Follow-up. J Clin Oncol 2021; 39: 1448-1457
    CrossrefPubMedSearch in Google Scholar
  • 12 Kunst N, Wang SY, Hood A. et al. Cost-Effectiveness of Neoadjuvant-Adjuvant Treatment Strategies for Women With ERBB2 (HER2)-Positive Breast Cancer. JAMA Netw Open 2020; 3: e2027074
    CrossrefPubMedSearch in Google Scholar
  • 13 Nitz UA, Gluz O, Christgen M. et al. De-escalation strategies in HER2-positive early breast cancer (EBC): final analysis of the WSG-ADAPT HER2+/HR– phase II trial: efficacy, safety, and predictive markers for 12 weeks of neoadjuvant dual blockade with trastuzumab and pertuzumab +/– weekly paclitaxel. Ann Oncol 2017; 28: 2768-2772
    CrossrefPubMedSearch in Google Scholar
  • 14 Fehm TN, Stickeler E, Fasching PA. et al. Update Breast Cancer 2021 Part 3 – Current Developments in the Treatment of Early Breast Cancer: Review and Assessment of Specialised Treatment Scenarios by an International Expert Panel. Geburtshilfe Frauenheilkd 2021; 81: 654-665
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Nitz U, Gluz O, Graeser M. et al. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR-): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23: 625-635
    CrossrefPubMedSearch in Google Scholar
  • 16 Hassett MJ, Li H, Burstein HJ. et al. Neoadjuvant treatment strategies for HER2-positive breast cancer: cost-effectiveness and quality of life outcomes. Breast Cancer Res Treat 2020; 181: 43-51
    CrossrefPubMedSearch in Google Scholar
  • 17 Luengo-Fernandez R, Leal J, Gray A. et al. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 2013; 14: 1165-1174
    CrossrefPubMedSearch in Google Scholar
  • 18 de la Maisonneuve C, Oliveira Martins J. Public Spending on Health and Long-term Care: A new set of projections. Paris: OECD Publishing; 2013
    Search in Google Scholar
  • 19 Lux MP, Nabieva N, Hartkopf AD. et al. Therapy Landscape in Patients with Metastatic HER2-Positive Breast Cancer: Data from the PRAEGNANT Real-World Breast Cancer Registry. Cancers (Basel) 2018; 11: 10
    CrossrefPubMedSearch in Google Scholar
  • 20 Lux MP, Beckmann MW. Organzentren und Zertifizierung: Chancen und Probleme. In: Wallwiener D, Grischke EM, Grischke S, Taran FA, Bastert G. Gynäkologische Onkologie. Begründet von Heinrich Schmidt-Matthiesen und Gunther Bastert. 8. Stuttgart: Schattauer; 2017: 439-446
    Search in Google Scholar
  • 21 Beckmann MW, Bader W, Bechtold I. et al. Finanzierung und finanzielle Probleme von Leistungen und Strukturen im Fachgebiet Gynäkologie und Geburtshilfe im Jahr 2011 – DRG-System und stationäre Versorgung inklusive Urogynäkologie und benigner wie auch maligner gynäkologischer Operationen. Geburtshilfe Frauenheilkd 2011; 71: 497-510
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Lux M, Hildebrandt T, Beyer-Finkler E. et al. Relevance of Health Economics in Breast Cancer Treatment – the View of Certified Breast Centres and Their Patients. Breast Care 2013; 8: 15-21
    CrossrefPubMedSearch in Google Scholar
  • 23 Barbier L, Declerck P, Simoens S. et al. The arrival of biosimilar monoclonal antibodies in oncology: clinical studies for trastuzumab biosimilars. Br J Cancer 2019; 121: 199-210
    CrossrefPubMedSearch in Google Scholar
  • 24 Hübel K, Kron F, Lux MP. Biosimilars in oncology: Effects on economy and therapeutic innovations. Eur J Cancer 2020; 139: 10-19
    CrossrefPubMedSearch in Google Scholar
  • 25 Cesarec A, Likić R. Budget Impact Analysis of Biosimilar Trastuzumab for the Treatment of Breast Cancer in Croatia. Appl Health Econ Health Policy 2017; 15: 277-286
    CrossrefPubMedSearch in Google Scholar
  • 26 Cuellar S. Integrating trastuzumab biosimilars and HER2-directed therapies into HER2-positive breast cancer management. Am J Manag Care 2020; 26 (Suppl. 02) S32-S40
    CrossrefPubMedSearch in Google Scholar