Sustainability of Eribulin treatment for patients with metastatic breast cancer: is the cost of the drug related to the benefit produced (Effectiveness and Safety)? A single center experience

Objective: To report the clinical outcomes and health care costs of Metastatic Breast Cancer patients treated with Eribulin, in the Medical Oncology Unit of the Messina University. Method: We retrospectively analyzed the costs associated with eribulin treatment in 15 MBC patients from January 2014 to December 2016 at Messina University Hospital. The PFS , ORR , DCR and the average cost of patient therapy were calculated. Result:15 patients were included in this analysis. They had received a median of 4 lines of therapy previously (including adjuvant treatment) and had significant visceral involvement (median 3 organs). A median of 4 cycles of eribulin was delivered. There were partial responses in 20% patients , stable disease status in 14% , and progressive disease in 66% . The median progression-free survival was 15 weeks (3.5 months), ORR was 20%, DCR was 33% . The most frequent treatmentrelated adverse events were neutropenia (26%), and febrile neutropenia (20%). Therapy for these patients resulted in a cost of euros 158.244,76. Assessing the repayment by the pharmaceutical company equals to euros 20.238,37 for non –responders patients , there is a net cost of euros 138.006,39. Conclusion: Our results have shown that treatment with eribulin applied to patients pretreated in III / IV metastatic line and beyond, so the high percentage of nonresponders is determined because of the already expired general conditions at the beginning of treatment. Despite this ,eribulin was shown to be an effective and safe therapeutic option in heavily pretreated patients with MBC. The costs associated with eribulin therapy have shown that payment by result contributes to making the cost of therapy more sustainable by the National Health Service.