Though the addition of pertuzumab to docetaxel and trastuzumab as first-line therapy for HER2-positive breast cancer has been shown to yield a substantial survival benefit, a new analysis shows that there is very little chance that pertuzumab would be cost effective in the United States.
The CLEOPATRA trial showed that pertuzumab along with docetaxel and trastuzumab (THP) resulted in a median survival in HER2-positive metastatic breast cancer patients of 56.5 months, compared with only 40.8 months for the latter two drugs alone (TH). “These exceptional results come at a price,” wrote researchers led by Ben Y. Durkee, MD, PhD, of Stanford University in California. “Our work shows that an insurer could expect to pay $4,649 per week for the THP regimen at Medicare rates. Private contractors and smaller entities would pay more.”
The researchers used a decision-analytic Markov model to evaluate the regimen’s cost effectiveness, based on the study population from CLEOPATRA and the assumed number of patients for whom the THP regimen would be recommended in the metastatic setting. Results were published online ahead of print in the Journal of Clinical Oncology.
The analysis found that the addition of pertuzumab to the TH regimen resulted in 1.82 life-years gained, and 0.64 quality-adjusted life years (QALYs) gained. The addition of pertuzumab had a cost of $713,219 per QALY gained. A further analysis showed a 0% chance of cost effectiveness at a willingness-to-pay level of $100,000 per QALY gained, and that result remained unchanged even up to a willingness-to-pay level of $500,000 per QALY gained.
The researchers estimated an annual incidence of 17,450 patients with metastatic HER2-positive breast cancer that would be eligible for the THP regimen. The direct costs for treating one such patient were $135,092 for TH, and $509,845 when pertuzumab was added. The incremental cost of adding pertuzumab for all such patients was $6.54 billion, which rose to $7.99 billion when the indirect costs were included. The total cost of cancer care in the United States is projected to be between $173 and $207 billion by 2020.
“The addition of pertuzumab to a standard regimen of TH for treatment of metastatic HER2-overexpressing breast cancer is unlikely to provide reasonable value for money spent in the United States compared with other interventions generally deemed cost effective,” the authors wrote. “This analysis highlights the economic challenges of extending life for patients with noncurable disease.”