Cost Evaluation of Subcutaneous Trastuzumab Versus Intravenous Trastuzumab for the Treatment of HER2-Positive Breast Cancer: Insights From Oncology Hospitals in Morocco

Abstract

Abstract Context: Over the course of over 20 years, trastuzumab has been a keystone in the treatment of human epidermal growth factor receptor 2–positive breast cancer. Trastuzumab administered both intravenously and subcutaneously show consistent pharmacokinetic characteristics and have been shown to have similar levels of safety and effectiveness. Objectives: Our study's main objective was to perform a thorough comparison of the medical and pharmaceutical expenses related to the two different pharmaceutical formulations. We specifically want to evaluate the financial effects of treating individuals weighing between 60 and 73 kg with trastuzumab, which was initially administered subcutaneously, in 1,474 treatment cases. Our study includes a simulation analysis that takes into account multiple scenarios and accounts for both the cost of the medication and the related medical bills. Results: From a database containing 542 patients with cancer, the study collected 4,437 therapy cases in total divided into three categories: initial dose, loading dose, and maintenance dose. 65.1% of the patients weighed less than 69 kg. In 62.9% of instances, the hospital pharmacy provided subcutaneous trastuzumab. For patients with cancer weighing between 60 and 73 kg, the simulated scenarios included the computation of overall expenses (subcutaneous [SC]: 1,370,516.60 USD and intravenous [IV]: 941,178.42 USD) and possible budget savings if the therapies were administered in IV rather than SC, totaling 428,765.60 USD. Conclusion: Beyond just taking medication costs into account, our research may help to clarify the differences between pharmaceutical formulations intended for IV and SC administration. In reality, we recognize that other variables—like the patient's weight and the financial models used by oncology institutions and health care workers—may also be quite important.