Societal Costs and Benefits of Treatment with Trastuzumab in Patients with Early HER2neu-Overexpressing Breast Cancer in Singapore

Table 1 Incremental Direct Costs and Benefits Associated with Trastuzumab in the Treatment of Early HER2neu-Positive Breast Cancer in Singapore

Cost Element				Hospital
			PMC 1	PMC 2	GRH 1	GRH2
HER2neu testing			615.10	410.50	133.00	322.14
Trastuzumab
	Direct Drug Costs		82,798.74	74,250.00	48,656.88	64,152.00
	Administration Costs		4,500.00	3,870.00	1,289.70	1,908.00
Extra Visits with Oncologist			1,170.00	1,498.00	350.00	749.00
Cardiac Monitoring			1,300.00	1,572.00	410.60	1,349.24
Cost of Cancer Recurrence
	Local Disease		12,500.00	12,500.00	12,353.00	12,059.75
	Metastatic Disease		124,767.00	117,714.00	95,525.56	108,325.20
Cost of Cardiac Toxicity			2,015.20	3,214.00	759.60	322.00
Total Incremental Cost (S$)			70,376.73	62,769.82	35,462.94	51,040.63
Incremental Costs in Singapore		S$ 50,512.63	US$ 24,130.16	(2009)
		S$ 44,879.82	US$ 26,971.05	(2005)

Notes to Table 1: PMC, private medical centre. GRH, government restructured hospital. HER2neu testing included costs of immunohistochemistry for all patients and fluorescence in-situ hybridization for 30% of patients. There were 12 extra visits with oncologist. Cardiac monitoring included 4 tri-monthly echocardiograms. Cost of local recurrence included mastectomy and hospital stay. Standard of care for patients who progressed on trastuzumab included (1) capecitabine + lapatinib, (2) capecitabine + trastuzumab and (3) trastuzumab + lapatinib. The estimate assumed that patients received 9 months of treatment with (1) or (2) followed by 3 months of treatment with (3). Excess Local recurrence without trastuzumab is estimated at 1% and estimated distant recurrence at 16% based on clinical trials. Cost of treatment of Cardiac toxicity was 4% × cost of 3-monthly cardiology visits + medications for 1 year

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