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Economic evaluation of trastuzumab in HER2-positive early breast cancer in Indonesia: A cost-effectiveness analysis

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  • Sudewi Mukaromah Khoirunnisa
  • Fithria Dyah Ayu Suryanegara
  • Didik Setiawan
  • Maarten Jacobus Postma
  • Lisa Aniek de Jong

Abstract

Background: Trastuzumab has significantly enhanced the survival and prognosis of individuals diagnosed with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. Considering its relatively high costs, we aimed to examine the cost-effectiveness of trastuzumab plus chemotherapy compared with chemotherapy alone in HER2-positive early breast cancer from an Indonesian healthcare payer’s perspective. Methods: A Markov model was developed to project the lifetime health benefits and costs associated with trastuzumab treatment for a cohort of women with HER2-positive early breast cancer. Efficacy data and baseline characteristics in the base-case analysis were primarily derived from the 11-year results of the HERA trial. Costs were based on verified reimbursement data from Indonesia’s Health and Social Security Agency (BPJS Kesehatan) of the year 2020. A scenario analysis was conducted with efficacy data based on the joint analysis from the NSABP B-31 and NCCTG N9831 trials, allowing for subgroup analysis by age at diagnosis. Univariate and probabilistic sensitivity analyses were conducted to assess the influence of parameter uncertainty. Results: In the base-case analysis, the results indicated that the lifetime costs for trastuzumab plus chemotherapy and chemotherapy alone were US$33,744 and US$22,720, respectively, resulting in substantial incremental savings of US$11,024 per patient for the former. Trastuzumab plus chemotherapy also led to higher total quality-adjusted life years (QALYs) and life years gained (LYG), resulting in incremental cost-effectiveness ratios (ICERs) of US$6,842 per QALY and US$5,510 per LYG. In scenario analysis, the subgroup with an age at diagnosis

Suggested Citation

  • Sudewi Mukaromah Khoirunnisa & Fithria Dyah Ayu Suryanegara & Didik Setiawan & Maarten Jacobus Postma & Lisa Aniek de Jong, 2024. "Economic evaluation of trastuzumab in HER2-positive early breast cancer in Indonesia: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 19(5), pages 1-16, May.
    • Handle: RePEc:plo:pone00:0304483
    DOI: 10.1371/journal.pone.0304483
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    References listed on IDEAS

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    1. J. Millar & Michael Millward, 2007. "Cost Effectiveness of Trastuzumab in the Adjuvant Treatment of Early Breast Cancer," PharmacoEconomics, Springer, vol. 25(5), pages 429-442, May.
    2. William Leung & Giorgi Kvizhinadze & Nisha Nair & Tony Blakely, 2016. "Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis," PLOS Medicine, Public Library of Science, vol. 13(8), pages 1-19, August.
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