The cost burden of trastuzumab and bevacizumab monoclonal antibody therapy in solid tumors: Can we afford it?

6044 Background: Monoclonal antibodies (MAb), such as trastuzumab (TZ) and bevacizumab (BZ), have become an important yet expensive component of cancer treatment. The potential cost impact on health care budgets needs to be assessed in the context of its potential utilization. An estimate of the additional costs incurred by adopting TZ and BZ therapy in breast (BRC), lung (LUC) and colorectal (CRC) cancers was undertaken. Methods: The MAb costs per patient were estimated based on treatment indications, length of treatment, standard doses / schedules and local pharmacy data. Supportive medications, diagnostics and health resources utilization only required for the MAb therapy were also examined. This analysis was performed in Canadian dollars ($), and assumes complete drug delivery and uncomplicated cycles. Drug costs were based on average 2005 wholesale prices in Canada. The analysis took a direct payer perspective. We subsequently estimated the cost of MAb therapy per patient relative to the total costs of conventional cancer management without MAb therapy. Budget impact estimates on Canada’s health care system were then derived according to constructed schema, which accounts for absolute numbers of target patients and systemic therapy utilization. Results: The average costs of TZ per treated patient were $47,278 and $26,648 for adjuvant and metastatic BRC, respectively. For BZ, these were $47,250 and $38,500 for metastatic LUC and CRC, respectively. Other costs associated with MAb therapy were in the range of 3–6%. The predicted TZ drug costs in metastatic breast cancer were within 10% of the actual costs derived from pharmacy data. The potential life-time absolute costs to Canada’s health care system were approximately $118 million for TZ, and $262 million for BZ. This corresponds to an average of approximately 21% increase in the health care expenditure for BRC, LUC, and CRC. Conclusions: MAb therapy, such as TZ and BZ, may add a significant cost burden to Canada’s publicly funded health care system. The developed schema in this analysis may be of potential use to health care providers and policy makers in assessing the impact of MAb therapy on health care budgets. No significant financial relationships to disclose.

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