Does Trastuzumab Offer Good Value for Money for Breast Cancer Patients with Metastasis in Indonesia?

Document Type : Research Articles


1 Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia.

2 Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

3 Clinical Epidemiology & Biostatistics Unit, Faculty of Medicine, Gadjah Mada University, Indonesia.

4 Department of Pharmacology, Faculty of Medicine, Sebelas Maret University, Indonesia.

5 Department of Pharmacology and Therapeutics, Faculty of Medicine, Lambung Mangkurat University, South Kalimantan, Indonesia.

6 Department Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia.

7 Department of Surgical Oncology, Dharmais National Cancer Center Hospital, Indonesia.

8 Department of Surgery, Faculty of Medicine, Udayana University/Sanglah General Hospital, Indonesia.

9 Faculty of Medicine, Lambung Mangkurat University/Ulin General Hospital, Indonesia.

10 Center for Financing and Health Insurance, Ministry of Health, Indonesia.

11 Faculty of Public Health, Universitas Indonesia, Indonesia.


Objective: Breast cancer is the most common cancer in Indonesia, with Indonesia’s breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia. Methods: We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost–utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs). Result: From a healthcare provider’s perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million. Conclusion: In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not cost-effective in terms of PFS and OS compared with chemotherapy alone.


Main Subjects

Volume 23, Issue 7
July 2022
Pages 2441-2447
  • Receive Date: 10 March 2022
  • Revise Date: 24 April 2022
  • Accept Date: 22 July 2022
  • First Publish Date: 22 July 2022