The treatment needs of the nearly 50% of women with metastatic breast cancer in British Columbia who could benefit from continued access to treatment for HER2 would cost the province at most an additional $68,000 per patient, due to the changing treatment landscape, a review of outcomes and pharmacy data suggests.
British Columbia’s current funding policy restricts patients to only two options of HER2-directed treatment for metastatic breast carcinoma. However, accessing ongoing HER2 suppression has become more complicated as new treatments have been developed. Emily Jackson, MD and colleagues presented their findings at the San Antonio Breast Cancer Symposium in the poster PD8-09.
The continued suppression of HER2 has helped improve progression free survival (PFS) and overall survival (OS), but the financial implications of adjusting the policies for funding to “reflect the increasing number of lines of HER2 treatment” are unclear and they emphasized.
The provincial government offers drug funding but it can take months or even years after the drug is approved for use by Health Canada. Once provincial protocols are approved, funding is made available. Jackson, co-chief resident (PGY5) at BC Cancer in Vancouver, said in an interview.
During this “lag time,” the province is negociating prices for drugs with pharmaceutical companies, and determining “which patients are eligible and under which circumstances,” she said.
The researchers used data from the BC Cancer outcomes Unit to determine the potential cost. This unit collects information about clinical and outcome data for 85percent of breast cancer patients in BC. Information on therapy use was obtained from the BC Cancer pharmacy database.
Out of the 230 patients that had received any HER2 treatment in metastatic breast cancer that was administered at BC Cancer between 2013-2018, 112 (49%) were eligible for further therapy.
“86 of these patients accessed continued HER2-directed treatment while 26 were eligible but were unable to access continued HER2Rx,” the authors stated. They also noted that “the remaining 51% (n=118) were not eligible to be considered for further HER2Rx due to either having stable disease (n=61) or have seen deterioration (n=57).
At a median follow-up time of 42.2 months, the median number of therapy lines in the entire population of patients was three. The median number of cycles for those who received HER2-directed therapy prior to second-line therapy was 33.
The median overall survival was 37.5 months for those who were eligible but did continue HER2, compared to 57.9 months for those who did continue, they discovered.
The overall difference in survival was not statistically significant ( P =.13) however Jackson declared that this was likely due the small number of patients included in the initial study. Jackson also noted that Jackson believes the finding is “hypothesis-generating” and must be further examined.
She said that most patients who received HER2 therapy continued the treatment through clinical trials or through compassionate access programs of pharmaceutical companies.
The “conservative estimated cost per cycle of HER2Rx” was calculated based on the current available trastuzumab biosimilars and the possible financial implications were calculated based on the current costs of third-line treatments that are commonly used.
The findings demonstrate that most patients receive continued treatment even if there are prohibitive funding policies, and suggest that significant cost increases per patient could be expected when funding policies aren’t adapted to meet the demands of treatment as they concluded. They also noted that “if these trends in survival continue we can expect an additional cost of $68,000 per patient over current costs.
“As the costs of the new therapies are likely to be higher than currently available biosimilars there will be significant consequences for both private and public health systems that are based on payers,” they added.
Jackson stated that a more extensive and more thorough analysis of the data was being planned. Jackson did not disclose any conflicts of interest or financial sources.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
Content Source: https://www.medscape.com/viewarticle/964675?src=rss
