ABSTRACT
BACKGROUND: Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20-25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). METHODS: Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012-2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015-2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. RESULTS: AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375, with pertuzumab accounting for 13,978 (24.79%) and increasing in 15,982 the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370 per percentage point of pCR. CONCLUSIONS: ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.
ABSTRACT
INTRODUCTION: Cancer is the second most common cause of death in Portugal, with 24.3% of these deaths caused by malignant neoplasms. The strong impact on lost productivity and rising treatment costs make cancer a priority. In order to understand, compare, and control costs by promoting transparency in the health system, it is vital to analyse the cost of oncological diseases. This study aims to estimate the economic burden associated with the treatment of cancer in Portugal by calculating the direct medical costs. MATERIALS AND METHODS: A prevalence-based study was conducted. The approaches used to estimate the costs were the top-down and gross costing techniques. In order to identify, quantify, and value all of the costs associated with the treatment of cancer, several sources of data were consulted to obtain the most up-to-date information on hospital care and a modified Delphi Panel was created to obtain data on primary health care. RESULTS: The annual cost of cancer treatment in Portugal amounted to 867 million euros, representing 5.5% of the total expenditure for health and 84 euros per capita. The main component of this cost is antineoplastic drugs, which account for 31.5% of the total. DISCUSSION AND CONCLUSION: By comparing the costs calculated in this study with those of the single Portuguese study conducted in 2009 and the European study carried out in 2013, we found that the annual cost for cancer treatment increased by about 300 million euros. An increase in incidence and the rising cost of drugs can explain this difference.
ABSTRACT
In this work, we considered the feasibility of Raman spectroscopy for discriminating between adenocarcinomatous and normal mucosal formalin-fixed colonic tissues. Unlike earlier studies in colorectal cancer, a spectral deconvolution model was implemented to derive spectral information. Eleven samples of human colon were used, and 55 spectra were analyzed. Each spectrum was resolved into 25 bands from 975 to 1720 cm(-1), where modes of proteins, lipids, and nucleic acids are observed. From a comparative study of band intensities, those presenting higher differences between tissue types were correlated to biochemical assignments. Results from fitting procedure were further used as inputs for linear discriminant analysis, where combinations of band intensities and intensity ratios were tested, yielding accuracies up to 81%. This analysis yields objective discriminating parameters after fitting optimization. The bands with higher diagnosis relevance detected by spectra deconvolution enable to confine the study to some spectral regions instead of broader ranges. A critical view upon limitations of this approach is presented, along with a comparison of our results to earlier ones obtained in fresh colonic tissues. This enabled to assess the effect of formalin fixation in colonic tissues, and determine its relevance in the present analysis.