Economic Policy (How-To): Herceptin for HER2+ Breast Cancer in the UK

January 13, 2016

EXECUTIVE SUMMARY

In 2012, 51,130 people developed invasive breast cancer in the UK (Cancer Research UK, 2016). Herceptin is a potential treatment for HER2+ breast cancer but its cost effectiveness is questionable. Results from many settings show that this treatment is not cost effective. Additional factors include: numbers exceeding NICE threshold, growing issue of trastuzumab-resistance not yet addressed, and the impending release of generics. This policy document therefore recommends offering this treatment for HER2+ breast cancer in the UK until the release of generics in the UK.

INTRODUCTION

Breast cancer is the most common cancer among women in the United Kingdom. In 2012, there were 51,130 new cases of invasive breast cancer (Cancer Research UK, 2016). Human epidermal growth factor 2 positive (HER2+) breast cancer account for 20-25% of all invasive cancers (Davis et al., 2014). The brand Herceptin (clinically known as trastuzumab), introduced in 1998 (Breast Cancer Deadline), is a clinically effective drug in managing HER2+ breast cancer (Hall and Cameron, 2009). However, there is controversy over the cost-effectiveness of this drug. Given the evidence reviewed, this policy document contends that Herceptin is not cost-effective in managing HER2+ breast cancer.

RESULTS

Adjusting for inflation from a 2006 study, the cost per life year saved for adjuvant Herceptin treatment ranged between £58,624 to £136,787 (Norum et al, 2005). A cross-country systematic review from 2014 showed that the incremental costs per person ran up to £52,111, and the QALYs gained were only in the range of 0.28 to 0.704 (Parkinson, et al 2014). According to the National Institute for Health and Care Excellence (NICE), the threshold for cost-effective treatment is £30,000 per quality adjusted life year (QALY). None of the evaluations reported fall below the threshold of £30,000 per QALY. Finally, Wilkin and Maihle (2010) found that resistance to Herceptin in early stage breast cancer patients was 20%, and for patients with metastatic breast cancer, 70%.

CONCLUSION/RECOMMENDATIONS

The cost of Herceptin treatment for HER2 +breast cancer is above NICE’s £30,000 per QALY threshold. Resistance has shown to be high which may add to costs, further research on resistance is required. We recommend another cost-effective analysis to be carried out in future, as generic alternatives are set to become available soon. Additionally, the BBC (2010) has reported that members of the medical community are concerned that Herceptin provision will take funding away from more cost-effective treatments. Finally, within the constraints of the UK health budget, Herceptin as a treatment for breast cancer is not a recommended course of action.

References:

Breast Cancer Deadline (nd) Trastuzumab.http://www.breastcancerdeadline2020.org/breast-cancer-information/specific-issues-in-breast-cancer/trastuzumab/ Accessed online on January 19, 2016.

BBC News (2006) Herceptin costs ‘threaten care’. http://news.bbc.co.uk/1/hi/health/6176008.stm. Accessed online on January 19, 2016. Cancer Research UK (2016) Breast Cancer Statistics. http://www.cancerresearchuk.org/health-professional/breast-cancer-statistics. Accessed online on January 19, 2016.

Davis, NM et al. (2014).Deregulation of the EGFR/PI3K/PTEN/Akt/mTORC1 pathway in breast cancer: possibilities for therapeutic intervention. Oncotarget 5(13), 4603–4650.

GaBI (2015) Biosimilar trastuzumab candidates in phase III development. Generics and Biosimilars Initiative Journal. Hall, PS and Cameron, DA (2009) Current perspective–trastuzumab. European Journal of Cancer 45(1), pp.12-18.

Norum, J et al. (2005) A Monoclonal antibody against HER-2 (trastuzumab) for metastatic breast cancer: a model-based cost-effectiveness analysis.” Annals of Oncology 16(6), pp. 909-914. Annonc.oxfordjournals.org. Accessed online on January 19, 2016.

Parkinson B et al. (2014) Economic evaluations of trastuzumab in HER2-positive metastatic cancer: a systemic review and critique. European Journal Health Economics 15, pp. 93–112

Wilken, JA and Maihle, NJ (2010). Primary trastuzumab resistance: new tricks for an old drug. Annals of the New York Academy of Sciences 1210. </i>