Summary
Breast cancer brain metastases (BCBM) occur when cancer cells spread from the breast to the brain and represent a substantial clinical and economic challenge for the NHS. mutTNF (mutant tumour necrosis factor) is a novel therapy designed to temporarily open the blood–brain barrier at sites of brain metastases, improving the delivery of treatments to tumours in the brain.
Health Innovation Oxford and Thames Valley (HIOTV) conducted an early health economic evaluation of mutTNF, mapping the clinical care pathway and developing a cost-effectiveness model to explore its potential value for the NHS.
What is the challenge?
Breast cancer brain metastases are associated with poor prognosis and high healthcare costs within the NHS. In early disease, the blood–brain barrier blocks most chemotherapy drugs from entering the brain and later it lets some through, which limits how well treatments work. At the same time, new treatments that work by helping medicines cross the brain’s protective barrier, like mutTNF, are still unproven and their future cost is unclear, so early economic analysis is needed to guide development and support future NHS decisions.
What did we do?
We carried out an early health economic evaluation of mutTNF in breast cancer brain metastases. We mapped the current care pathway and built a cost-effectiveness model to understand how improving delivery of treatment to tumours in the brain could affect patient outcomes and NHS costs. We also explored different scenarios and estimated the potential price range at which mutTNF could still represent good value for the NHS.
What has been achieved?
Our work provided early evidence on the potential value of treatments that help therapies reach tumours in the brain in breast cancer brain metastases. The analysis also produced a flexible economic modelling framework that can be adapted for other cancers that metastasise to the brain, supporting future research and evaluation.
The early findings were used to support a grant application for real‑world evaluation. We also presented the work as a poster at the ISPOR conference, where the abstract was selected among the top 5% of submissions. In addition, we are preparing a health economic manuscript to further share the results.
Lessons learned
The project highlighted the importance of early health economic evaluation in guiding the development of emerging therapies. When clinical effectiveness and pricing remain uncertain, threshold analysis can be particularly valuable for exploring potential value and informing development decisions. The work also showed how methodology-led analysis can generate useful insights even when clinical evidence is still evolving.
Scalability/next steps
This work provides a strong foundation for further development. Following the breast cancer brain metastases evaluation, Health Innovation Oxford and Thames Valley, in collaboration with the University of Oxford, has undertaken additional economic evaluations of mutTNF in other cancers that metastasise to the brain, including lung cancer and melanoma. Each evaluation was designed specifically to reflect the distinct clinical context, care pathways, and treatment patterns within each indication, while assessing the potential value of mutTNF within an NHS setting.
Collectively, this programme of work strengthens the early evidence base for mutTNF across multiple tumour types and demonstrates the applicability of economic evaluation in supporting development decisions in areas of high unmet need.
Further work will focus on generating real-world evidence to validate and refine these early findings, alongside developing return-on-investment (ROI) assessments to support future decision-making. This work will also inform trial design, patient and public involvement activities, and longer-term considerations around pricing, reimbursement, and potential NHS commissioning.
What they said
Working with Health Innovation Oxford and Thames Valley on this project has been extremely positive, they took time to fully understand mutTNF and its potential clinical application and, subsequently, produced a comprehensive independent analysis of the health economics benefits of mutTNF in clinical care for breast cancer patients. The results of this analysis are pivotal in supporting our case for onward clinical translation and demonstrating the potential clinical benefits of mutTNF.” – Nicola Sibson, Professor of Imaging Neuroscience, University of Oxford
Contact
Ankur Chauhan, Senior Health Economist & Methodologist, ankur.chauhan@healthinnovationoxford.org