Abstract
Introduction: Breast cancer with overexpression of human epidermal growth factor 2 (HER-2) accounts for 18 to 30% of cases of this disease¹. Currently, the Unified Health System (SUS) provides intravenous trastuzumab (IVT) and IV pertuzumab (IVP) associated with cytotoxic chemotherapy for patients with metastatic breast cancer¹. Another option, not available in the SUS, is P+T SC, which has similar efficacy and safety to IVP + IVT². From the patient's perspective, P+T SC is preferable, as it allows for a reduction in administration time³. Furthermore, the SC route minimizes the risks of invasive access routes, such as infections, thrombosis, and discomfort associated with the catheter4. In the logistical and financial scenario, SC formulations of immunobiologicals, when compared to IV drugs, are responsible for reducing the working time of health professionals, patient waiting times, and associated costs4,5. Objective: To describe and compare the costs between P+T SC and P IV + T IV in the treatment of metastatic HER-2+ breast cancer. Material and Method: Study developed using the health costing method. It was carried out at the Pernambuco Cancer Hospital (HCP), in June 2024, based on secondary data obtained from the HCP's computerized system and a report by the National Commission for the Incorporation of Technologies into the SUS (CONITEC). To carry out the study, a comparison was made between the actual expenses of the standardized protocol at the institution (P IV + T IV) and the hypothetical expenses of P+T SC, considering the population that underwent P IV + T IV in the month of the study. The values of the protocols were produced with the prices of the technologies and the inputs used in the manipulation and administration. Results: From the data collection, the sample consisted of 185 patients, with an average weight of 70 kg and who underwent a cycle of the standard protocol. Therefore, the unit cost of this protocol was approximately R$31,181.05 for the loading dose and R$17,454.02 for the maintenance dose. According to CONITEC, the estimated price of the P+T SC loading dose is R$13,586.44 and R$7,375.64 for the maintenance dose. Considering that all patients underwent the maintenance regimen with the standard protocol, the approximate average monthly cost was R$3,228,993.70. In addition, 277 hours and 30 minutes of infusion were spent. Based on this same number of patients, R$1,364,493.40 would be spent on the use of P+T SC, with an infusion time of 15 hours and 42 minutes. Thus, it is estimated that the incorporation of P+T SC would enable savings of R$1,864,500.30 per month, in addition to the time spent with one patient in the IV protocol allowing the care of 18 patients with P+T SC. Conclusions: Thus, in addition to the direct cost reduction of P+T SC in relation to the standard protocol, this medication has the advantage of reducing the infusion time, which enables the care of a greater number of patients, reducing their length of stay in the hospital, in addition to helping to speed up the flow of other protocols.
