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. 2014 Sep 5:14:372.
doi: 10.1186/1472-6963-14-372.

Societal cost-effectiveness analysis of the 21-gene assay in estrogen-receptor-positive, lymph-node-negative early-stage breast cancer in Japan

Hideko Yamauchi, Chizuko Nakagawa, Shinji Yamashige, Hiroyuki Takei, Hiroshi Yagata, Atsushi Yoshida, Naoki Hayashi, John Hornberger  1 , Tiffany Yu, Calvin Chao, Carl Yoshizawa, Seigo Nakamura
Affiliations

Societal cost-effectiveness analysis of the 21-gene assay in estrogen-receptor-positive, lymph-node-negative early-stage breast cancer in Japan

Hideko Yamauchi et al. BMC Health Serv Res. .

Abstract

Background: Breast-cancer incidence and mortality have been increasing in Japan. Japanese-specific clinical validity and utility data for the 21-gene assay (Oncotype DX® Breast Cancer Assay; Genomic Health, Inc., Redwood City, USA) are now available. The objective of this study was to evaluate the cost-effectiveness of the 21-gene assay for the guidance of adjuvant chemotherapy decisions in estrogen-receptor-positive, lymph-node-negative, early-stage breast cancer patients, from the Japanese societal perspective.

Methods: The recurrence risk group distribution by the 21-gene assay result and the assay's influence on adjuvant chemotherapy recommendations were obtained from a study of 104 patients. A state-transition cohort (Markov) model tracked time from surgery until distant recurrence and from distant recurrence to death. Adjuvant chemotherapy benefit by 21-gene assay risk group was based on published clinical validation studies. Direct and indirect medical costs were obtained from the referral centers. Utilities associated with progression and chemotherapy-related adverse events were extracted from literature. Sensitivity analyses assessed the key drivers and robustness of the primary outcomes.

Results: The 21-gene assay identified 48% of patients as low-risk, 36% as intermediate-risk, and 16% as high-risk. Total acute chemotherapy-related costs decreased by ¥154,066 due to less adjuvant chemotherapy usage. In the high-risk group, adjuvant chemotherapy use increased 18%, leading to survival benefits. Chemotherapy use overall decreased by 19%. Monitoring costs increased by ¥3,744 but recurrence costs declined by ¥46,113 per patient. Use of the 21-gene assay increased quality-adjusted-life-years (QALYs) by 0.241 per patient on average; the net cost per QALY gained was ¥636,752 ($6,368).

Conclusions: The 21-gene assay for women with estrogen-receptor-positive, lymph-node-negative, early-stage breast cancer is projected to be cost-effective in Japan.

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Figures

Figure 1
Figure 1
Markov diagram. The level of recurrence risk is based on the 21-gene assay. Quotation marks indicate values unknown to physicians and patients. Abbreviation: aCT, adjuvant chemotherapy.
Figure 2
Figure 2
One-way sensitivity analysis tornado diagram: baseline recurrence risk from a Japan-based validation study. Abbreviations: aCT, adjuvant chemotherapy; AEs, adverse events; QALY, quality-adjusted–life-year; ¥, JPY, Japanese Yen in 2013 currency.
Figure 3
Figure 3
One-way sensitivity analysis tornado diagram: baseline recurrence risk from a US- and UK-based validation studies. Abbreviations: aCT, adjuvant chemotherapy; AEs, adverse events; QALY, quality-adjusted–life-year; ¥, JPY, Japanese Yen in 2013 currency.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6963/14/372/prepub

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