The new drug Enhertu inhibits an aggressive form of breast cancer for more than 15 months in people who can no longer cure. That is almost 9 months longer than standard treatment. Enhertu does have more side effects, but the benefits outweigh the drawbacks. That is why the National Health Care Institute advises the Minister of Health, Welfare and Sport to reimburse Enhertu from the basic package after a price reduction.
Targeted drug inhibits aggressive breast cancer metastasis
Enhertu (trastuzumab-deruxtecan) is a new drug for people with HER2-positive breast cancer who have metastases or who cannot be operated on and for whom previous treatment has failed (or has ceased to work). In HER2-positive breast cancer, the cancer cells divide rapidly. As a result, the risk of metastases is greater than with other forms of breast cancer. Enhertu is a targeted therapy that damages or clears the cancer cells without causing much damage to the healthy body cells. The drug thus inhibits further growth and metastasis of the cancer cells. The Zorginstituut estimates that 243 to 609 people with HER2-positive breast cancer are eligible for treatment with Enhertu each year.
Enhertu more effective than standard treatment
Scientific research is being done into the effect of Enhertu. Based on the interim results of this study, the Zorginstituut concludes that Enhertu has proven to be effective care for people with HER2-positive breast cancer who can no longer be cured. That is why the medicine can be reimbursed from the basic package. The study results only provide insight into the so-called progression-free survival. That is the period during a treatment in which the patient survives and the breast cancer no longer grows (quickly). For this survival, treatment with Enhertu is more effective than standard treatment with trastuzumab emtansine (Kadcyla). With Enhertu, the cancer is stopped for an average of 15.5 months, while with standard treatment it is an average of 6.8 months. The period in which people survive without the cancer spreading is therefore almost 9 months longer with Enhertu. Enhertu does have more side effects than trastuzumab emtansine, but these can be treated and are not permanent.
Price negotiation necessary due to uncertainties
The research into the effectiveness of Enhertu has not yet been completed. As a result, it is currently unknown what the effect of the drug is on overall survival (that is, the period from treatment until death) and quality of life. Due to these uncertainties about the health benefits for the patient, the Zorginstituut believes that Enhertu’s asking price is too high. That is why we advise the minister to negotiate a price reduction of at least 45% with the manufacturer. This means that other new medicines can also be included in the basic package. And there will still be sufficient financial scope to keep the existing good care from the basic package accessible to everyone in the Netherlands. Once all the results of the study are available, the Zorginstituut Enhertu can reassess at the request of the minister and advise again on the reimbursement.
About the National Health Care Institute
Everyone who lives or works in the Netherlands is obliged to have health insurance. Zorginstituut Nederland is a government organization whose main task is to compile the basic package of health insurance. We make complicated but necessary choices to ensure that everyone in the Netherlands can receive good care. Now and in the future.