Original article Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2 ) advanced breast cancer in Kazakhstan

Objective: The aim of this study was to determine the budget impact of everolimus (in combination with letrozole/ anastrozole) as asecond-line treatmentfor ERþHER2� negative advanced and metastatic breast cancer in post-menopausal women. Research design and methods: A cumulative cohort model was developed to estimate the 5-year costs associated with introducing everolimus to the Kazakh healthcare system. Two alternative market share scenarios were compared: with everolimus and without everolimus. PFS and OS data were taken from the trial and extrapolated. The background costs of the pre-progressed and post-progressed health states, drug costs and costs associated with adverse events were included in the model. Results: The 5-year results from the budget impact analysis demonstrate that the introduction of everolimus leads to a 12% increase in drug costs, a 2% reduction in pre-progression health state costs, a 1% increase in postprogression health state costs, and a 2% reduction in adverse event costs. The net result is only a modest increase in total costs; a 2.69% increase of T201 million, from T7.5 billion to T7.7 billion over a period of 5 years. Conclusions: The analysis estimated that, if everolimus were to be introduced to the Kazakh healthcare market for the treatment of ERþ HER2� advanced breast cancer, there would be minimal impact upon overall healthcare expenditure. An increase in drug acquisitions costs was almost exactly offset by a reduction in other healthcare costs, due to improved management of the disease.