UNLABELLED

CADTH recommends that Trodelvy should be reimbursed by public drug plans for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC) who have received 2 or more prior therapies, at least 1 of them for metastatic disease if certain conditions are met. Trodelvy should only be covered to treat patients with triple-negative breast cancer that has spread to other parts of the body or cannot be removed by surgery, and who have received 2 or more prior treatments, including at least 1 treatment for metastatic disease; and have good performance status. Trodelvy should only be reimbursed if it is prescribed by a clinician who is experienced in treating cancer. The price of Trodelvy must be lowered to be cost-effective and affordable. Evidence from a clinical trial demonstrated that Trodelvy was better than treatment of physician’s choice (TPC; i.e., eribulin, capecitabine, gemcitabine, or vinorelbine) in delaying the spread of triple-negative breast cancer and allowing patients to live longer. Based on public list prices, Trodelvy is not considered cost-effective at a willingness-to-pay threshold of $50,000 per quality-adjusted life-year (QALY) for patients included in the indication approved by Health Canada, relative to TPC. Economic evidence suggests that the price of Trodelvy needs to be reduced by at least 87% for it to be cost-effective at a $50,000 per QALY threshold. Based on public list prices, Trodelvy is expected to cost the public drug plans at least $72 million over 3 years.

ADDITIONAL INFORMATION

Breast cancer can be classified by proteins (receptors) expressed by the cancer cell. Some breast cancers do not have estrogen and progesterone hormone receptors and do not have much HER2 receptors. This is called triple-negative breast cancer and is considered unresectable locally advanced or metastatic when the cancer spreads to other parts of the body or cannot be removed by surgery. There are no effective treatments available for patients with triple-negative breast cancer. Many patients do not respond to available treatment options. Even for patients who do respond, the cancer may still return and spread in the breast or to another part of the body. Treatment with Trodelvy was estimated to cost approximately $12,478 per patient per cycle.