Powerful Breast Cancer Drug Carries High Price

Herceptin fights malignancy -- but at $40,000 a year, experts say

TUESDAY, Nov. 29, 2005 (HealthDay News) -- The high cost of the potent new breast cancer drug Herceptin could limit its use, a new Belgian study suggests.

Since a year's worth of Herceptin could cost upward of $45,000 in the United States, "there are experts in this country and in insurance agencies and Medicaid that have a lot of decisions to make," said Debbie Saslow, the director of breast and gynecological cancer at the American Cancer Society.

"This is what happens when lifesaving drugs come out that are very expensive," said Saslow, who was not involved in the study.

But even with its high cost, if Herceptin proves to be as effective at fighting early breast cancer as preliminary data suggest, it could still be cost-effective in certain subgroups of women, according to lead researcher Mattias Neyt, a health economist and research fellow at Ghent University.

His team's report appears in the Nov. 30 issue of the Annals of Oncology.

Herceptin (trastuzumab) is a humanized monoclonal antibody drug that targets breast cancers carrying a protein called HER2. HER2-positive cancers make up about a quarter of all breast malignancies.

Currently, Herceptin is licensed for use in advanced breast cancer, where it has been shown to extend survival. Four trials of its use in early breast cancer are under way and preliminary results are promising. There has been pressure from patients and others to make Herceptin available immediately, without waiting for the outcome of these trials.

But Herceptin's expense means that using it as therapy in early breast cancer could be a major financial burden on health-care systems, since large numbers of women might need the drug for long periods of time, the Belgian researchers noted.

"Herceptin is expensive," Neyt said. "Patients receiving Herceptin in an adjuvant setting receive it for a long period -- one year. The combination of high price plus large population plus long treatment results in high budget implications."

For example, the cost of providing the treatment in Belgium would be 25.5 million Euro ($30 million) or around 34,000 Euro ($40,000) per patient. Extending its use to earlier, stage I breast cancers would double that burden, Neyt said.

Since Herceptin is still being studied for use in early breast cancer, it is too soon to determine which patients are eligible for this treatment, Neyt added. "The economic analysis has to be done for specific subgroups of patients. Subgroups with a higher baseline risk will be more cost-effective," he said.

"Don't just look at the medical side of the story," Neyt said. "There is also an economic reality. Herceptin is a wonderful product but society has to be able to afford it. Money for health care can only be spent once. Well-considered decisions have to be taken and this is only possible if all available evidence is taken into account."

This study confirms some reports in the United States on the drug's benefits, Saslow said. "There is a lot of recent excitement about the preliminary data showing that this drug would be extremely beneficial and lifesaving to a good proportion of women with early breast cancer, not just late breast cancer," she said.

Saslow believes Herceptin might still be cost-effective. "The 25 to 30 percent of [early stage] breast cancer patients who might respond to this drug are the ones with the poorest prognosis," she said. "The cost of treating metastatic cancer is going to be more than the cost of preventing it."

Calls to Genentech, the maker of Herceptin, for comment were not returned.

More information

For more on breast cancer, head to the American Cancer Society.

SOURCES: Mattias Neyt, Ph.D., research fellow, Ghent University, Belgium; Debbie Saslow, Ph.D., director, breast and gynecological cancer, American Cancer Society, Atlanta; Nov. 30, 2005, Annals of Oncology
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