AI Insight
This cost-utility analysis compared five trastuzumab-based treatment regimens of varying durations (9-week to 24-month) against chemotherapy alone for HER2-positive breast cancer in Kenya, using a lifetime-horizon Markov state-transition model. The 9-week regimen demonstrated the lowest incremental cost-effectiveness ratio at USD 3,230 per QALY, compared to USD 4,046 to 9,846 per QALY for longer regimens, though none met Kenya's willingness-to-pay threshold of USD 1,054.80 per QALY. The 9-week regimen would consume only 1.2% of projected insurer budgets over five years, versus 2.82% for the currently recommended 12-month regimen.
Why it matters
In low- and middle-income countries like Kenya, where trastuzumab access is severely limited by cost, identifying shorter and more affordable regimens could meaningfully expand treatment access for HER2-positive breast cancer patients. The findings suggest that policy interventions such as drug price negotiations, biosimilar adoption, and vial-sharing programs could further improve affordability and cost-effectiveness.
⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Breast cancer was the leading cause of cancer-related mortality among women worldwide in 2022. In Kenya, more than a quarter of breast cancer patients have the aggressive Human Epidermal Growth Factor Receptor 2 positive subtype. Trastuzumab is recommended for its treatment, but high costs have limited access. This study evaluated the cost-effectiveness and affordability of trastuzumab-based regimens to inform their adoption and use in Kenya. A cost-utility analysis was conducted from the healthcare payer perspective over a lifetime horizon. Five trastuzumab-based regimens of varying durations (9-week, 6-month, 9-month, 12-month, and 24-month) were compared with chemotherapy alone. Direct medical costs were estimated using a bottom-up micro-ingredient approach. All costs were reported in 2022 USD. A cohort Markov state-transition model with a monthly cycle length was used to estimate the costs and outcomes for an open hypothetical cohort. Scenario, deterministic sensitivity and probabilistic sensitivity analyses were conducted. A budget impact analysis estimated the financial implications of each regimen. The 9-week regimen had the lowest incremental cost-effectiveness ratio (ICER) of USD 3,230 per QALY, while the remaining regimens had ICERs ranging from USD 4,046 to 9,846 per QALY. The findings were most sensitive to the price and quantity utilized per cycle of trastuzumab. A reimbursement cap of KES 40,000 per cycle reduced ICERs by up to 61%. Over five years, the 9-week regimen would account for 1.2% of the projected insurers budget, whereas the current recommended 12-month regimen would consume 2.82%. Although none of the regimens were cost-effective at Kenyas WTP threshold (USD 1054.80), the 9-week regimen may still be considered by policymakers given its greater affordability. Further cost reductions can be achieved through negotiating lower drug prices, improving access to biosimilars, and implementing vial sharing.