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. 2019 Oct;26(5):307-318.
doi: 10.3747/co.26.4769. Epub 2019 Oct 1.

Cost-utility analysis of 21-gene assay for node-positive early breast cancer

L Masucci  1 , S Torres  2 , A Eisen  2   3 , M Trudeau  2   3 , I Tyono  2 , H Saunders  1 , K W Chan  2   3   4 , W Isaranuwatchai  1   4   5
Affiliations

Cost-utility analysis of 21-gene assay for node-positive early breast cancer

L Masucci et al. Curr Oncol. 2019 Oct.

Abstract

Background: For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer.

Methods: A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis.

Results: The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice.

Conclusions: Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.

Keywords: 21-gene assay; Cost-effectiveness; breast cancer; chemotherapy.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare the following interests: funding for this study was received by Genomic Health Ltd. However, the research was conducted independently of Genomic Health Ltd. AE received funding from Genomic Health Ltd. for a decision study in which she was the principal investigator. ST received funding from Genomic Health Ltd. for a decision study in which she was a co-investigator and also fellowship support from Genomic Health Ltd. MT received funding from Genomic Health Ltd. for a decision study in which she was a co-investigator. IT received fees as an advisory board member for Teva Pharmaceuticals. LM, KWC, HS, and WI have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Markov model used for the analysis. CHF = congestive heart failure.
FIGURE 2
FIGURE 2
Cost-effectiveness plane, with 10,000 simulated incremental cost-effectiveness ratios from probabilistic analysis. WTP = willingness to pay.
FIGURE 3
FIGURE 3
Cost-effectiveness acceptability curve. RS = Recurrence Score (Oncotype dx: Genomic Health, Redwood City, CA, U.S.A.).
See this image and copyright information in PMC

References

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