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

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 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.