Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early-stage breast cancer: a cost-effectiveness evaluation in the German setting.
J Med Econ
; 16(1): 30-40, 2013.
Article
en En
| MEDLINE
| ID: mdl-22966753
ABSTRACT
OBJECTIVE:
The 21-gene assay (Oncotype DX Breast Cancer Test (Genomic Health Inc., Redwood City, CA)) is a well validated test that predicts the likelihood of adjuvant chemotherapy benefit and the 10-year risk of distant recurrence in patients with ER+, HER2- early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Germany.METHODS:
A Markov model was developed to make long-term projections of distant recurrence, survival, quality-adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative, or up to 3 node-positive early-stage breast cancer. Scenarios using conventional diagnostic procedures or the 21-gene assay to inform treatment recommendations for adjuvant chemotherapy were modeled based on a prospective, multi-center trial in 366 patients. Transition probabilities and risk adjustment were based on published landmark trials. Costs (2011 Euros ()) were estimated from a sick fund perspective based on resource use in patients receiving chemotherapy. Future costs and clinical benefits were discounted at 3% annually.RESULTS:
The 21-gene assay was projected to increase mean life expectancy by 0.06 years and quality-adjusted life expectancy by 0.06 quality-adjusted life years (QALYs) compared with current clinical practice over a 30-year time horizon. Clinical benefits were driven by optimized allocation of adjuvant chemotherapy. Costs from a healthcare payer perspective were lower with the 21-gene assay by â¼561 vs standard of care. Probabilistic sensitivity analysis indicated that there was an 87% probability that the 21-gene assay would be dominant (cost and life saving) to standard of care.LIMITATIONS:
Country-specific data on the risk of distant recurrence and quality-of-life were not available.CONCLUSIONS:
Guiding decision-making on adjuvant chemotherapy using the 21-gene assay was projected to improve survival, quality-adjusted life expectancy, and be cost saving vs the current standard of care women with ER+, HER2- early-stage breast cancer.
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Neoplasias de la Mama
/
Quimioterapia Adyuvante
Tipo de estudio:
Clinical_trials
/
Guideline
/
Health_economic_evaluation
/
Prognostic_studies
Límite:
Adult
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Aged
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Female
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Humans
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Med Econ
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2013
Tipo del documento:
Article
País de afiliación:
Alemania