OBJECTIVES: Breast cancer (BC) is the most prevalent cancer globally, with 2.3 million women diagnosed in 2022 (WHO). Intravenous (IV) infusions of chemotherapies and biologics are widely utilized, and subcutaneous (SC) treatments have come to the market in recent years. While SC treatments are expected to save time and resources compared to IV, a systematic analysis of cost savings has not been conducted.

METHODS: We conducted a literature search on Embase and Medline databases to identify cost-minimization analyses published since database inception till June 2024 comparing SC and IV BC treatments globally.

RESULTS: 18 studies were considered relevant, with 16 evaluating trastuzumab (T) monotherapy, and two evaluating the fixed-dose combination of pertuzumab and trastuzumab (PH FDC) for the treatment of HER2+ BC. Per patient cost savings reported with T SC vs. T IV in overall HER2+ BC patients for treatment course were €3,153 in Russia in 2015, €5,892 in North Macedonia in 2015, €1,248 in Greece in 2017, €1,786.58 in Ireland in 2019, and $10,017.44 in Hong Kong in 2023. Per patient cost savings reported for early stage (ES) HER2+ BC patients were €1,132.43 in Spain in 2017 for treatment course, $6,241 per year in Chile in 2020 and 45.11-232.16 million VND in Vietnam in 2020 for treatment course. In ES, using PH FDC SC, non-drug cost saving per patient over treatment course ranged €2,474-€8,975 in Western Europe and $10,138 in the US in 2021 compared to P and T IV. For metastatic stage (MS), savings were 25.52-91.65 million VND in Vietnam in 2020 for treatment course. In MS, annual cost savings per patient with PH FDC SC were $5,395 in Peru in 2023.

CONCLUSIONS: These findings suggest SC T and PH FDC are more economical in HER2+ BC. However, continued research is required to establish economic benefits across interventions for BC.