Assessment of HER2+ Breast Cancer Management at Instituto Oncológico Nacional, Panama

Abstract BackgroundCancer is a disease with high mortality. New treatments require high levels of investment that must be carefully considered by healthcare systems. In this setting, we describe a methodology for supporting decision-making and analyzing the clinical and economic impact of new innovative targeted therapies in the current management landscape. MethodsAn MS Excel multivariate model was constructed to assess the clinical and economic impact of current disease management and the estimated impact of potential new targeted therapies. ResultsThe Instituto Oncológico Nacional (ION) of Panama currently spends $6m annually on the management of 135 new patients with HER2-positive breast cancer, achieving a 5-year overall survival (OS) of 89%, 86% and 18% in adjuvant, neoadjuvant and metastatic disease, respectively. Currently, targeted therapies other than trastuzumab are funded for metastatic stage disease progression and for initial treatment in the neoadjuvant stage. Investment in adjuvant treatments for adjuvant and neoadjuvant disease, and in the metastatic stage would increase 5-year OS to 90%, 86% and 25% respectively (absolute increase of 1%, 0.5% and 7%, respectively). ConclusionsThe 5-year OS at the ION is close to international standards for early-stage disease. However, there are opportunity areas in metastatic disease, if the use of available innovative targeted therapies increased. Although early-stage patients have the highest cure possibilities and defined costs, investment in first-line treatment of metastatic disease delays disease progression and offers a high clinical impact in overall survival, both in relative and absolute terms.