Updated cost comparison of home care subcutaneous versus outpatient intravenous trastuzumab for HER2-positive breast cancer in Singapore

Background: With major changes in effective drug prices, we updated our earlier cost-minimization analysis comparing home-based subcutaneous (SC) trastuzumab with outpatient intravenous (IV) trastuzumab for HER2-positive breast cancer in Singapore. Objectives: To compare updated annual per-patient costs of home care SC versus outpatient IV trastuzumab. Design: A cost-minimization analysis was performed. Methods: We conducted a model-based cost-minimization analysis using micro-costing from a societal perspective, incorporating both direct and indirect costs. A Monte Carlo simulation was performed to account for parameter uncertainties. Results: Annual per-patient cost was S$21,790 (95% uncertainty interval (UI): S$19,662–23,922) for home care versus S$6949 (95% UI: S$5347–10,782) for outpatient care, representing a 214% increase. While service delivery (manpower, facility, consumables) and productivity loss remained cheaper in home care, drug cost is the dominant factor of overall expenditure in trastuzumab delivery. Conclusion: At current drug prices, outpatient IV trastuzumab administration is the cost-saving option, compared with home care SC trastuzumab.