Minimización de costos de aplicación subcutánea o intravenosa de trastuzumab y pertuzumab en pacientes con cáncer mamario

Introduction: Pharmacoeconomic evaluation of drugs for HER2-positive breast cancer is important, due to the high cost of these medications. Efficacy and safety results of combined subcutaneous administration of trastuzumab and pertuzumab are not lower than those of intravenous administration. Objective: Compare the costs of three options for the combined administration of trastuzumab and pertuzumab: 1) in separate vials, both intravenous drugs; 2) subcutaneous trastuzumab and intravenous pertuzumab; and 3) both drugs in a single vial, subcutaneous. Methods: A cost minimization analysis was performed of a one-year period. Attention was paid to costs associated to the administration of anti-HER2 drugs in 18-dose schemes, including the cost of specific drugs, consumables, human resources and monitoring. Univariate sensitivity analysis was carried out, in which the price of anti-HER2 drugs was varied ±10-30%. Results: Total cost of combined subcutaneous administration of trastuzumab and pertuzumab at fixed doses was 26% lower than the separate vials scheme for anti-Her2 intravenous administration and 6% lower than the hybrid regimen. The time saved per treatment session per patient by scheme 3 was 83.8% of scheme 1 and 68% of scheme 2. Sensitivity analysis found that the subcutaneous treatment scheme was less costly than the intravenous scheme even when product costs are increased 30%. Conclusions: Combined administration of trastuzumab and pertuzumab at fixed subcutaneous doses is more cost-effective and offers more organizational benefits to oncological services than other schemes. It is also a safe and efficient alternative for the national health system in the treatment of patients with HER2-positive breast cancer. Key words: breast cancer; phamacoeconomics; trastuzumab; pertuzumab.