In a Belgian study published (Wednesday 30 November) in Annals of Oncology, health economist Mattias Neyt said that if the drug turns out to be as powerful in early breast cancer as preliminary results show, then it may well be cost effective for certain sub-groups.
However, using it as adjuvant therapy in early disease could impose a major financial burden on healthcare systems because of the high drug price, the long duration of treatment and the large numbers of women who would be eligible. If patients are not to be denied the treatment, healthcare authorities will have to bargain over the drug price and be prepared to reallocate resources and de-list older non-cost effective treatments in order to meet the demand.
Mr Neyt, a research fellow at Ghent University, said: "In Belgium there are over 6,600 cases of breast cancer a year. About 45% are stage II or III the first sub-groups in which adjuvant therapy would probably be used and about a quarter of these would have the type of breast cancer that responds to Herceptin. This means that about 750 women each year would be eligible. The cost of providing the treatment in Belgium would be 25.5 million Euro or around 34,000 Euro per patient for Herceptin drug costs alone. Extending its use to stage I breast cancers would double the burden.
He said these costs could be even higher in some countries because the price of the drug varies widely. For example, in Norway, at current prices, Herceptin is 928 Euro per 150mg vial, compared with 647 Euro per vial in Belgium. In the UK, the price to the National Health Service is about 595 Euro.
Herceptin (trastuzumab) is a humanised monoclonal