Is a Shorter Trastuzumab Duration a Cost-Effective Option in HER2+ Breast Cancer?

In recent years, several studies have attempted to show that a shorter course of trastuzumab than the traditional 1 year could offer similar results in some patients with HER2-positive breast cancer, with mixed results. The shorter course of therapy, though, does appear to be substantially more cost-effective than the longer duration of treatment, according to a new analysis.

The analysis, based on the PERSEPHONE trial, was presented at the European Society for Medical Oncology (ESMO) 2018 Congress, held in Munich. At the same conference, other researchers presented results of a subgroup analysis of the Short-HER trial, which showed noninferiority with 9 weeks of trastuzumab in certain patients. The PERSEPHONE trial, in contrast, compared 12 months of trastuzumab with 6 months, and did show noninferiority of that shorter regimen in results published earlier this year.

The new cost efficacy analysis included data from 4,009 patients who were disease free at 6 months; the researchers, led by Claire Hulme, a professor of health economics at Leeds University in the United Kingdom, conducted a landmark analysis comparing the two treatment regimens with regard to health service activity and costs, as well as quality of life.

The average costs for a patient treated with 6 months of trastuzumab were £2,538.64 (approximately $3,226), compared with £12,333.83 (approximately $15,675) for those treated for 12 months. This gave an average cost savings of £9,793.25 (approximately $12,447) per patient. The bulk of the savings came from decreased use of trastuzumab itself, with the remainder accounted for by cardiac assessment and treatment costs and inpatient days.

The average quality-adjusted life years for a patient treated with 6 months of trastuzumab was 1.146, compared with 1.128 in the 12-month group. The probability of the 6-month duration of treatment being cost-effective was 100%.

“The results, alongside the clinical effectiveness results demonstrating noninferiority, are the first steps in the safe reduction of treatment for many women with HER2-positive breast cancer,” Hulme said. “They present an opportunity for significant cost savings for health service providers.”

Nadia Harbeck, MD, of the University of Munich, commented on the study, and she pointed out that subgroup analysis in the PERSEPHONE trial could not rule out benefit of 1 year of trastuzumab in clinically relevant subgroups, so that should remain the standard for the moment.

Still, she called the economic analysis important. “We should not do these trials assuming ‘one size fits all’ for the whole population but we should take into account patients’ individual responses to neoadjuvant anti-HER2 therapy and ask the question whether patients who have sufficient response may forgo further therapy.”