ABSTRACT
PURPOSE: A clinical-genomic prognostic multigene panel (RI-DR assay, RecurIndex®), predicting the risk level of distant recurrence (DR) in early-stage breast cancer (EBC) patients with an Asian background, has been validated as a valuable tool for identifying high-risk patients to develop distant recurrence (metastasis). Although the clinical benefit of adjuvant chemotherapy from the assay's prediction is already proved, its affordability remains uncertain. This study is the first time in which the long-term cost-effectiveness of the RI-DR assay is evaluated. PATIENTS AND METHODS: A lifetime Markov decision-analytic model was developed from a societal perspective to estimate the life-years gained (LYGs), quality-adjusted life-years (QALYs), medical costs, and incremental cost-effectiveness ratios (ICERs), comparing EBC women with and without RI-DR genomic testing. A decision tree was used to classify patients in one of the fifteen end nodes (by order, each arm was stratified by a patient being tested or not with the RI-DR assay, being treated or not with adjuvant chemotherapy and had no, minor, major, or fatal toxicity after adjuvant chemotherapy). Health utilities, costs, transition probabilities, and survival data were extracted from the scientific literature. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed on variables to assess the robustness of the model. A willingness-to-pay (WTP) threshold of 790,000 NT$ per QALY gained was considered as a cost-effectiveness criterion. RESULTS: The incremental cost per QALY gained under base-case assumptions of the model was 173,842 NT$. Findings on the variation in model input parameters were robust and confirmed that every key variable was cost-effective for the benefit of RI-DR testing. CONCLUSION: The clinical-genomic RI-DR assay is cost-effective in guiding adjuvant chemotherapy decisions compared to current clinical practice guidelines.
ABSTRACT
Tuberculosis is the leading cause of death for notifiable diseases in Taiwan. The incidence rate of tuberculosis for aborigines is 3.1 times higher than the general population, and the mortality rate for the aboriginal population is 3.2 times higher than the rate for the rest of Taiwan. The proportion of tuberculosis retreatment cases among aborigines is higher than the general population, and this is why tuberculosis is widespread in aboriginal communities. To determine the risk factors for retreatment cases living in an aboriginal village, a case-control study was performed. From January 2000 to June 2004, a total of 60 confirmed tuberculosis cases were enrolled. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. Epidemiological data were collected by structured questionnaires. Comparisons of proportions were done by chi-square test. Of the 60 cases, 19 were retreatment patients. Most education levels among the study subjects were elementary and junior high school. The majority of occupations were farmer and laborers. The Odds Ratios (ORs) of 'poor compliance' and 'not receiving DOTS' in the retreatment-patient group were significantly increased compared with the new patient group. In March 24, 2005, CDC-Taiwan vowed to halve the tuberculosis incidence and mortality by 2015. To accomplish this goal, CDC-Taiwan is investing funds and personnel in the National Tuberculosis Plan (2005-2015). The plan commits the government to implementing DOTS, to enhance the public health and medical networks for the country, especially for aboriginal villagers.