Abstract
Introduction The neoadjuvant treatment of breast cancer for patients with overexpression of human epidermal growth factor 2 (HER-2+) recommended by the Unified Health System (SUS) is the intravenous monoclonal antibody trastuzumab (IVT) for 4 or 6 cycles, associated with the chemotherapy treatment of choice¹. Another alternative that presents equivalent efficacy and safety is P+T SC, but it is not available in the SUS². Objective: To compare the costs between P+T SC and IVT in the adjuvant treatment of HER-2+ breast cancer. Material and Method: Health costing method, developed at the Pernambuco Cancer Hospital (HCP), in June 2024, based on secondary data obtained from the HCP computerized system and a report from the National Commission for the Incorporation of Technologies into the SUS (CONITEC). Initially, a survey was conducted to determine the number of registered patients undergoing IV T and the costs of this treatment. Subsequently, a comparison was made between the costs of IV T and P+T SC in neoadjuvant therapy, as well as between P+T SC in neoadjuvant therapy and IV trastuzumab and pertuzumab (IV T + P) in the metastatic setting. Results: The study sample consisted of 231 patients with an average weight of 70 kg. With the completion of 4 cycles (1 attack and 3 maintenance) of IV T, R$2,604,458.01 was spent. Assuming that the same patients were treated with P+T SC, R$8,153,551.56 would be spent in 4 cycles. Although the costs of P+T SC are higher, the results of the NeoSphere and PEONY research present a promising scenario for cost analysis. In these studies, it was observed, respectively, that 17% and 18% of patients using P+T SC achieved Complete Pathological Response (CPR)3,4. Therefore, if 17% of the initial sample presents CPR, 39 patients will not present metastasis and, consequently, will not undergo the metastatic treatment protocol (T + P IV), which has a unit cost of R$33,181.05 per loading dose and R$17,454.02 for maintenance. The average number of cycles performed by patients with metastatic breast cancer at the institution is 18, therefore, 702 cycles would not be performed, representing a cost of R$12,866,075.00, generating a savings of R$4,712,524.00 in the group of patients who underwent P+T SC in neoadjuvant therapy. Furthermore, in the loading dose, T IV is administered in 1 hour and 30 minutes (min) and in 30 min for maintenance. P+T SC is administered in 8 min for the attack dose and 5 min for maintenance, thus the use of the SC formulation allows the treatment of 6 to 11 patients in the same time as the IV formulation. Conclusions: The benefits of P+T SC are related to the reduction of costs with patients who would no longer progress to the metastatic scenario. In addition, for treatment with IV T, approximately 4 vials (FA) are used for the attack dose and 3 FA for maintenance, while with the use of P+T SC, 1 FA is used. This reduction optimizes the drug storage process, in addition to benefiting the environment by reducing the production of biological waste.
