Economic evaluation of pertuzumab in early versus late settings of HER2-positive breast cancer: a systematic review

Background Significant clinical benefit has been demonstrated in multiple clinical trials of the humanised antibody pertuzumab in breast cancer patients overexpressing the Human Epidermal Growth Factor-2 (HER2) receptor. However, economic evaluations of pertuzumab treatment have yielded conflicting results regarding its cost-effectiveness in this patient population. Objectives The objective of this study was to assess all current economic evaluations of pertuzumab in patients with primary versus metastatic breast cancer, and to provide an overview of the cost effectiveness of pertuzumab in these settings. Methods Using Ovid MEDLINE, EMBASE, CINAHL EBSCO and Cochrane, a systematic review was conducted of economic evaluations of pertuzumab in breast cancer patients. Studies were subdivided into those assessing pertuzumab in early breast cancer with high-risk patients and in patients with metastases. Results A total of 888 articles were retrieved from Ovid MEDLINE, PubMed and Embase. An additional 70 articles were gathered from CINAHL EBSCO and Cochrane. Following removal of duplicates, 570 articles were screened by title, resulting in 330 screened by abstract and a total of 72 full-text articles screened for final inclusion. A total of 5 studies assessing the cost-effectiveness of pertuzumab in the early breast cancer setting and 8 studies in the metastatic setting were included in the final analysis. pertuzumab was found to be cost-effective in the early breast cancer setting, but generally not cost-effective in the metastatic setting. Conclusion Pertuzumab consistently produces high pathological complete response (pCR) rates and has a significant impact on long term patient health outcomes and survival. For patients with early breast cancer with high-risk features, the lower lifetime costs associated with pertuzumab treatment make it cost- effective. However, in patients with metastatic breast cancer, the cost associated with ongoing treatment of this costly monoclonal antibody therapy argues against the economic viability of pertuzumab.