Treatment optimization of HER2-positive breast cancer from the standpoint of efficiency and economic viability
Authors:   A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation, Zelenova O.V. , Sterlikov S.A. ,   Russian Research Institute of Health (RIH), Moscow, Russian Federation,   Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation, Abramov S.I. ,   Russian Research Institute of Health (RIH), Moscow, Russian Federation, Germanovich N.Yu. ,   A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation, Abramov A.S. ,   N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation
Published: September 2024

Background: the topic of effective and economically viable treatment of HER2+ breast cancer does not lose its relevance. Due to the established system of clinical examination and oncological services in the Russian Federation, HER2-positive breast cancer is diagnosed at an early stage in the vast majority of cases. With the implementation of contemporary neoadjuvant and adjuvant pharmacotherapy regimens, this allows for the expectation of complete recovery and restoration of work capacity. Aim: to determine the potential contribution of implementing modern treatment tactics for HER2-positive breast cancer to the key performance indicators characterizing the oncological care system efficacy, and to evaluate the impact of optimal therapy regimens for early-stage HER2- positive breast cancer on the cost savings associated with the patient management with possible disease recurrence. Materials and Methods: a clinical and epidemiological simulator has been developed to forecast performance indicators such as first-year mortality after diagnosis, accumulation of patient cohorts at early stages of malignant tumors (MT), five-year survival rates of patients with MT, and overall survival. With its help, an assessment of changes in the service performance indicators has been conducted upon the implementation of optimal treatment methods (within the framework of clinical guidelines by the Ministry of Health of Russian Federation) using breast cancer as an example. The evaluation includes direct medical costs for providing medical care funded by compulsory health insurance, federal budget resources, and regional budgets. Additionally, an economic assessment of direct medical costs for preferential drug provision for patients with recurrent HER2-positive breast cancer and the potential cost savings due to an increase in saved lives in the medium term (3–5 years) perspective has been conducted. Results: the use of optimal therapy regimens in neoadjuvant and adjuvant modes allows for budget savings in the medium term by reducing the number of patients with possible recurrence within the first three years. This positively impacts the overall expenditure, which on a national scale would not only prevent recurrence in more than 500 patients but also save over 3 billion rubles. Conclusion: modeling using the developed calculator enables the comparison of direct expenses for HER2+ breast cancer pharmacotherapy with epidemiological indicators of healthcare system performance in the Russian Federation's regional cancer control program. Integration of optimal therapy regimens into routine practice by oncologists is essential for achieving superior clinical outcomes, which in turn translates to more efficient utilization of healthcare budgets. KEYWORDS: breast cancer, HER2+, clinical and epidemiological simulator, organization of population-based cancer control programs, economic assessment of direct medical costs, economic viability. FOR CITATION: Zelenova O.V., Sterlikov S.A., Abramov S.I., Germanovich N.Yu., Abramov A.S. Treatment optimization of HER2-positive breast cancer from the standpoint of efficiency and economic viability. Russian Medical Inquiry. 2024;8(6):321–331 (in Russ.). DOI: 10.32364/2587-6821-2024-8-6-2.