ABC chromogenic agar: a cost-effective alternative to standard enteric media for Salmonella spp. isolation from routine stool samples

Salmonellosis is the second most common cause of bacterial gastroenteritis, yet the yield from routine stool culture is low. Commonly used selective enteric media have poor specificities for salmonella identification, resulting in a high laboratory workload. A special chromogenic medium, ABC agar, is a promising alternative but its cost-effectiveness has not been evaluated in diagnostic laboratories. A collaborative study is therefore undertaken in two district general hospitals laboratories. Routine stool samples (n=866) were subcultured onto ABC agar half plates after selective enrichment in selenite broth. Similarly, 246 and 620 stool samples were subcultured onto desoxycholate lactose sucrose (DCLS) and xylose lactose desoxycholate (XLD) whole agar plates, respectively. Salmonella spp. were isolated from only 14 (1.6%) of stool samples tested. Specificity was significantly higher for ABC (98%) than DCLS (67%) or XLD (78%) agars. Welcan workload units (ABC 4.8, XLD and DCLS both 7.3) and costs per specimen (ABC 1.26 pounds sterling, DCLS 3.81 pounds sterling and XLD 1.83 pounds sterling) were similarly lower with ABC agar. The results indicate that ABC chromogenic agar offers improvements in specificity, workload and costs over conventional enteric media for Salmonella spp. isolation.

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: a study protocol

INTRODUCTION

Medication errors are the most frequent cause of preventable harm in hospitals. Medication management in paediatric patients is particularly complex and consequently potential for harms are greater than in adults. Electronic medication management (eMM) systems are heralded as a highly effective intervention to reduce adverse drug events (ADEs), yet internationally evidence of their effectiveness in paediatric populations is limited. This study will assess the effectiveness of an eMM system to reduce medication errors, ADEs and length of stay (LOS). The study will also investigate system impact on clinical work processes.

METHODS AND ANALYSIS

A stepped-wedge cluster randomised controlled trial (SWCRCT) will measure changes pre-eMM and post-eMM system implementation in prescribing and medication administration error (MAE) rates, potential and actual ADEs, and average LOS. In stage 1, 8 wards within the first paediatric hospital will be randomised to receive the eMM system 1 week apart. In stage 2, the second paediatric hospital will randomise implementation of a modified eMM and outcomes will be assessed. Prescribing errors will be identified through record reviews, and MAEs through direct observation of nurses and record reviews. Actual and potential severity will be assigned. Outcomes will be assessed at the patient-level using mixed models, taking into account correlation of admissions within wards and multiple admissions for the same patient, with adjustment for potential confounders. Interviews and direct observation of clinicians will investigate the effects of the system on workflow. Data from site 1 will be used to develop improvements in the eMM and implemented at site 2, where the SWCRCT design will be repeated (stage 2).

ETHICS AND DISSEMINATION

The research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospitals Network and Macquarie University. Results will be reported through academic journals and seminar and conference presentations.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) 370325.

Numerical Analysis of Microcellular Injection Molding

This study presents a simulation model for the microcellular injection molding process in which supercritical fluid such as carbon dioxide or nitrogen is mixed with molten polymer and injected into the mold. Our model simulates the development of cells in the melt during injection molding. The effects of cell growth on material properties and flow have been investigated. Some simulation results such as melt pressure and final cell size distribution are compared with experimental results.

Goal planning: a retrospective audit of rehabilitation process and outcome

Objective: To consider the effectiveness of a goal planning programme for people with spinal cord injury (SCI) and address some of the current evidence gaps in goal setting.

Design: Retrospective audit.

Subjects: Consecutive series of 65 newly injured SCI patients.

Main outcome measures: The Needs Assessment Checklist (NAC) has been specifically developed for the SCI population, and is used to assess patient attainment in core rehabilitation areas. A ‘Goal Planning Progress’ form was also used to specifically detail the goal planning process.

Results: Across the 65 patients, 396 goal planning meetings were held with 6176 goals set in total. Seventy-two per cent of the goals set at the first goal planning meeting were achieved by the second meeting. The rate of achievement at subsequent meetings was 68%. Significant differences in the number of planned rehabilitation days, number of goal planning meetings, and goals set were identified between injury categories. Significant positive correlations were found between the number of goals set and achievement, as measured by the NAC, in certain rehabilitation domains.

Conclusions: The findings of this study demonstrate that the Needs Assessment and Goal Planning framework is effective in planning SCI rehabilitation. The capacity of this goal planning system to reflect individual need has also been established. Further systematic analyses of this process could potentially lead to more efficient rehabilitation and the identification of care pathways within clinical areas.

An audit of demographics and rehabilitation outcomes in non-traumatic spinal cord injury

STUDY DESIGN

Repeated measures, retrospective cohort study.

OBJECTIVES

To classify specific causes of injury in a cohort of non-traumatic spinal cord injury (NTSCI) patients, with the aim of exploring whether there are differences in demographics or rehabilitation outcomes depending on the cause of NTSCI.

SETTING

Tertiary care, spinal cord injury rehabilitation unit.

METHODS

Patients admitted to the unit with a non-traumatic SCI between July 2008 and April 2015 were considered for this study. Demographic information and rehabilitation outcomes were obtained from the Needs Assessment Checklist (NAC). NAC1 is completed within 4 weeks post mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data were obtained for 265 patients.

RESULTS

The most common causes were vertebral column degenerative disorders, infection and vascular disorders, which together accounted for 80% of all NTSCI in this sample. Patients with vertebral column degenerative disorders were less likely to have a complete injury than patients with infections or vascular disorders. There were differences in rehabilitation outcomes on several domains of the NAC. Overall, patients with an SCI caused by an infection have the highest needs (more dependent), and patients with vertebral column degenerative disorders have the lowest needs (more independent).

CONCLUSION

The relationship between non-traumatic cause of injury and rehabilitation outcomes may be mediated by severity of injury. Individuals with infection-related NTSCI are more likely to be complete, therefore, present more significant rehab needs, and lower rehabilitation outcomes particularly in physical health, activities of daily living and bowel management domains. This supports previous findings of Kay et al. and provides a possible explanation for the differences. This further informs future interventions.

Pilot and Feasibility Trial Evaluating Immuno-Gene Therapy of Malignant Mesothelioma Using Intrapleural Delivery of Adenovirus-IFNα Combined with Chemotherapy

PURPOSE

"In situ vaccination" using immunogene therapy has the ability to induce polyclonal antitumor responses directed by the patient's immune system.

EXPERIMENTAL DESIGN

Patients with unresectable malignant pleural mesothelioma (MPM) received two intrapleural doses of a replication-defective adenoviral vector containing the human IFNα2b gene (Ad.IFN) concomitant with a 14-day course of celecoxib followed by chemotherapy. Primary outcomes were safety, toxicity, and objective response rate; secondary outcomes included progression-free and overall survival. Biocorrelates on blood and tumor were measured.

RESULTS

Forty subjects were treated: 18 received first-line pemetrexed-based chemotherapy, 22 received second-line chemotherapy with pemetrexed (n = 7) or gemcitabine (n = 15). Treatment was generally well tolerated. The overall response rate was 25%, and the disease control rate was 88%. Median overall survival (MOS) for all patients with epithelial histology was 21 months versus 7 months for patients with nonepithelial histology. MOS in the first-line cohort was 12.5 months, whereas MOS for the second-line cohort was 21.5 months, with 32% of patients alive at 2 years. No biologic parameters were found to correlate with response, including numbers of activated blood T cells or NK cells, regulatory T cells in blood, peak levels of IFNα in blood or pleural fluid, induction of antitumor antibodies, nor an immune-gene signature in pretreatment biopsies.

CONCLUSIONS

The combination of intrapleural Ad.IFN, celecoxib, and chemotherapy proved safe in patients with MPM. OS rate was significantly higher than historical controls in the second-line group. Results of this study support proceeding with a multicenter randomized clinical trial of chemo-immunogene therapy versus standard chemotherapy alone. Clin Cancer Res; 22(15); 3791-800. ©2016 AACR.

Production of Human papillomavirus pseudovirions in plants and their use in pseudovirion-based neutralisation assays in mammalian cells

Human papillomaviruses (HPV) cause cervical cancer and have recently also been implicated in mouth, laryngeal and anogenital cancers. There are three commercially available prophylactic vaccines that show good efficacy; however, efforts to develop second-generation vaccines that are more affordable, stable and elicit a wider spectrum of cross-neutralising immunity are still ongoing. Testing antisera elicited by current and candidate HPV vaccines for neutralizing antibodies is done using a HPV pseudovirion (PsV)-based neutralisation assay (PBNA). PsVs are produced by transfection of mammalian cell cultures with plasmids expressing L1 and L2 capsid proteins, and a reporter gene plasmid, a highly expensive process. We investigated making HPV-16 PsVs in plants, in order to develop a cheaper alternative. The secreted embryonic alkaline phosphatase (SEAP) reporter gene and promoter were cloned into a geminivirus-derived plant expression vector, in order to produce circular dsDNA replicons. This was co-introduced into Nicotiana benthamiana plants with vectors expressing L1 and L2 via agroinfiltration, and presumptive PsVs were purified. The PsVs contained DNA, and could be successfully used for PBNA with anti-HPV antibodies. This is the first demonstration of the production of mammalian pseudovirions in plants, and the first demonstration of the potential of plants to make DNA vaccines.

A versatile retarding potential analyzer for nano-satellite platforms

The design of the first retarding potential analyzer (RPA) built specifically for use on resource-limited cubesat platforms is described. The size, mass, and power consumption are consistent with the limitations of a nano-satellite, but the performance specifications are commensurate with those of RPAs flown on much larger platforms. The instrument is capable of measuring the ion density, temperature, and the ram component of the ion velocity in the spacecraft reference frame, while also providing estimates of the ion composition. The mechanical and electrical designs are described, as are the operating modes, command and data structure, and timing scheme. Test data obtained using an ion source inside a laboratory vacuum chamber are presented to validate the performance of the new design.

Measuring laboratory-based influenza surveillance capacity: development of the 'International Influenza Laboratory Capacity Review' Tool

OBJECTIVES

The 2005 International Health Regulations (IHR 2005) emphasized the importance of laboratory capacity to detect emerging diseases including novel influenza viruses. To support IHR 2005 requirements and the need to enhance influenza laboratory surveillance capacity, the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) Influenza Division developed the International Influenza Laboratory Capacity Review (Tool).

STUDY DESIGN

Data from 37 assessments were reviewed and analyzed to verify that the quantitative analysis results accurately depicted a laboratory's capacity and capabilities.

METHODS

Subject matter experts in influenza and laboratory practice used an iterative approach to develop the Tool incorporating feedback and lessons learnt through piloting and implementation. To systematically analyze assessment data, a quantitative framework for analysis was added to the Tool.

RESULTS

The review indicated that changes in scores consistently reflected enhanced or decreased capacity. The review process also validated the utility of adding a quantitative analysis component to the assessments and the benefit of establishing a baseline from which to compare future assessments in a standardized way.

CONCLUSIONS

Use of the Tool has provided APHL, CDC and each assessed laboratory with a standardized analysis of the laboratory's capacity. The information generated is used to improve laboratory systems for laboratory testing and enhance influenza surveillance globally. We describe the development of the Tool and lessons learnt.

Abstract LB-208: Open air fluorescence imaging of tumors using a new, hands-free translational imaging system

Intraoperative tumor resection currently relies on the ability of a surgeon to visually detect and/or palpate the tumor and tumor margins. Small tumor nodules can be missed or tumor margins may be inadequately removed, resulting in the need for secondary treatment. Intraoperative fluorescence imaging can help improve the initial resection and, therefore, both improve outcomes and reduce cost. Unconjugated fluorescent dyes have been previously used for this type of study to identify tumors in first-in-human studies. However, dyes conjugated to a targeting moiety have better specificity for the tumor itself and provide better guidance for the surgeon to locate the tumor and remove margins.

The new Solaris imaging system is an open air fluorescence imaging instrument designed specifically for intraoperative imaging in small to large animals. The system supports 4 different fluorescence channels to image common dyes (e.g. indocyanine green [ICG] and Fluorescein isothiocyanate [FITC]) and more unique near-infrared (NIR) fluorescent dyes. All of these can be imaged in ambient light to achieve sensitivities of 10 nM for single, long exposures and 10-100 nM for videos. The imaging head is attached to an adjustable arm so that it be can be positioned 75 cm above the object plane, far enough to be considered outside of the sterile field. The imaging head also has two cameras for simultaneous fluorescence and bright field (color) imaging; these images can be overlaid in the software. Single, long exposure images acquired from 2 different wavelengths can be overlaid to enable multiplexing and improve tumor identification; previously published studies have shown this to be useful for sentinel lymph node detection. For FITC, a custom liquid crystal tunable filter (LCTF) is included in the system in tandem with spectral unmixing software to separate tissue autofluorescence from fluorescence emitted by the dye.

Although this system is designed for larger animals, proof of concept intraoperative tumor resection has been performed in rodents. Subcutaneous tumors have been resected while imaging mice injected with either the targeted agent IntegriSense™ 680 or the activatable agent ProSense® 750. To investigate a more challenging model, tumor cell lines have also been implanted intrasplenically in rats. After injection with either the targeted agent BombesinRSense™ 680 or the activatable agent MMPSense® 750, deep tissue tumors can be identified intraoperatively and removed. Both the residual tumor bed (in vivo) and the resected tumors (ex vivo) can be imaged to confirm complete resection. In addition, although there are depth limitations due to the absorption and scattering of light in tissue, images acquired using a rat osteoarthritis model also provides insight into the ability to detect targeted fluorescence agents non-invasively. These results suggest that intraoperative resection of tumors detected with both targeted and activatable fluorescent agents is feasible using the new Solaris imaging system.

Citation Format: Jeffrey A. Meganck, Kristine Vasquez, Jeffrey Peterson, Chris Condron, Ali Behrooz, Josh Kempner, Alexandra de Lille, Yiyong Tan, Pete Harvey, Hongyan Gu, Paul Kennedy, Mathew Roxo, Ilias Faqir, Yan Zhang, Leo Mirkin, Peter Miller, Wael Yared. Open air fluorescence imaging of tumors using a new, hands-free translational imaging system. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-208. doi:10.1158/1538-7445.AM2015-LB-208

Return-to-work intentions during spinal cord injury rehabilitation: an audit of employment outcomes

STUDY DESIGN

Single-centre, retrospective cohort study.

OBJECTIVES

To analyse the return-to-work intentions during spinal cord injury (SCI) rehabilitation.

SETTING

Tertiary care, spinal cord injury rehabilitation unit, National Spinal Injuries Centre, Stoke Mandeville Hospital, Ayelsbury, UK.

METHODS

Employment outcomes were obtained from the Needs Assessment Checklist (NAC), for all patients admitted to the unit between February 2008 and October 2014. NAC1 is completed within 4 weeks post-mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data from 362 participants were analysed for return-to-work intentions, by gender, age and injury severity.

RESULTS

Seventy-six percent of the sample population was employed at the time of their injury. At NAC1, 22.4% of individuals had made plans to return to work, whereas 44.2% had not; at NAC2, 34.3% had made plans to return to work and 31.2% had not. This difference was found to be statistically significant. There were significant differences in return-to-work intentions by injury severity at NAC1 but not NAC2, and by age group at NAC2 but not NAC1.

CONCLUSION

Less than half of those employed at the time of their injury had made plans to return to work before their discharge from the unit. The low proportion of individuals with SCI returning to work--just one in three--is concerning in view of the lost health and psychosocial benefits, and requires greater prominence during rehabilitation. Future research into effective employment interventions to improve employment outcomes in this population is required.

Rare complications of a low lying median arcuate coeliac ligament

Pancreaticoduodenal artery aneurysm is a rare complication of coeliac artery stenosis secondary to a low lying median arcuate coeliac ligament. This article reports the case of a 69-year old man who presented with left arm and leg weakness, clinically in keeping with right hemisphere stroke. Initial CT brain scan was within normal limits. The patient did not receive thrombolysis as he was outside the time window. 3 hours later the patient experienced sudden onset epigastric pain and acute shock. CT aorta abdominal was diagnostic of a ruptured inferior pancreaticoduodenal artery aneurysm. Repeat CT brain the following day showed subacute infarction within the right frontal lobe. Embolisation of the aneurysm was successfully performed. It is well documented that ischaemic stroke can cause acute hypertension. This acute hypertension probably contributed to the rupture of the pancreaticoduodenal artery aneurysm. The patient was well on discharge and remains well 2 months on.

Quality of life in and after spinal cord injury rehabilitation: a longitudinal multicenter study

PURPOSE

To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury.

METHOD

Longitudinal multiple sample multiple wave panel design. Data included 292 patients recruited from Austrian British German Irish and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks 12 weeks 1 year and 2 years after injury to both samples.

RESULTS

Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical environmental and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time.

CONCLUSION

QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English-and German-speaking countries.

A statistical approach to investigating enhancement of polonium-210 in the Eastern Irish Sea arising from discharges from a former phosphate processing plant

Since the cessation of phosphoric acid production (in 1992) and subsequent closure and decommissioning (2004) of the Rhodia Consumer Specialties Limited plant in Whitehaven, the concentration levels of polonium-210 ((210)Po) in local marine materials have declined towards a level more typical of natural background. However, enhanced concentrations of (210)Po and lead-210 ((210)Pb), due to this historic industrial activity (plant discharges and ingrowth of (210)Po from (210)Pb), have been observed in fish and shellfish samples collected from this area over the last 20 years. The results of this monitoring, and assessments of the dose from these radionuclides, to high-rate aquatic food consumers are published annually in the Radioactivity in Food and the Environment (RIFE) report series. The RIFE assessment uses a simple approach to determine whether and by how much activity is enhanced above the normal background. As a potential tool to improve the assessment of enhanced concentrations of (210)Po in routine dose assessments, a formal statistical test, where the null hypothesis is that the Whitehaven area is contaminated with (210)Po, was applied to sample data. This statistical, modified "green", test has been used in assessments of chemicals by the OSPAR commission. It involves comparison of the reported environmental concentrations of (210)Po in a given aquatic species against its corresponding Background Assessment Concentration (BAC), which is based upon environmental samples collected from regions assumed to be not enhanced by industrial sources of (210)Po, over the period for which regular monitoring data are available (1990-2010). Unlike RIFE, these BAC values take account of the variability of the natural background level. As an example, for 2010 data, crab, lobster, mussels and winkles passed the modified "green" test (i.e. the null hypothesis is rejected) and as such are deemed not to be enhanced. Since the cessation of phosphoric acid production in 1992, the modified "green" test pass rate for crustaceans is ∼53% and ∼64% for molluscs. Results of dose calculations are made (i) using the RIFE approach and (ii) with the application of the modified "green" test, where samples passing the modified "green" test are assumed to have background levels and hence zero enhancement of (210)Po. Applying the modified "green" test reduces the dose on average by 44% over the period of this study (1990-2010).

Are ant supercolonies crucibles of a new major transition in evolution?

The biological hierarchy of genes, cells, organisms and societies is a fundamental reality in the living world. This hierarchy of entities did not arise ex nihilo at the origin of life, but rather has been serially generated by a succession of critical events known as 'evolutionary transitions in individuality' (ETIs). Given the sequential nature of ETIs, it is natural to look for candidates to form the next hierarchical tier. We analyse claims that these candidates are found among 'supercolonies', ant populations in which discrete nests cooperate as part of a wider collective, in ways redolent of cells in a multicellular organism. Examining earlier empirical work and new data within the recently proposed 'Darwinian space' framework, we offer a novel analysis of the evolutionary status of supercolonies and show how certain key conditions might be satisfied in any future process transforming these collaborative networks into true Darwinian individuals.

Real-time 4D phase unwrapping applied to magnetic resonance elastography

PURPOSE

Phase amplitude is a source of signal in magnetic resonance elastography (MRE) experiments but its exploitation in experimental design has been limited due to the challenges of phase wrap. This study addressed this aspect of MRE through new developments in algorithms, heuristic strategy, and user interface.

METHODS

A test dataset with systematic variation of three parameters-nested wrap, gradient, and noise level-was developed to choose phase-unwrapping algorithms and to analyze their performance. A new application, PhaseTools, was developed that implemented three phase-unwrapping algorithms that adhere to a "real-time" criterion of less than 3 min for a four-dimensional MRE acquisition. Two of the algorithms extend previously published algorithms and one was newly developed. The algorithms were then applied to five datasets from MRE, two typical cases and three edge cases that were particularly challenging in one of the three parameters.

RESULTS

The performance of the PhaseTools algorithms on the test dataset was comparable to two widely cited algorithms that take hours or days to complete. Guidelines for the optimal use of each algorithm are established.

CONCLUSION

PhaseTools enables the substantial increase of signal-to-noise in MRE experiments at negligible additional computational cost. PhaseTools is freely released with this study, making robust real-time phase unwrapping available to any group using phase-based imaging.

Performance of the Medtronic Sentrino continuous glucose management (CGM) system in the cardiac intensive care unit

BACKGROUND

Maintaining glucose in the target range, while avoiding hypoglycemia, is challenging in critically ill patients. We investigated the performance and safety of Medtronic Sentrino, a newly developed continuous glucose management (CGM) system for critically ill adults.

METHODS

This was a prospective, single-center, single-arm, open-label study in adult patients with cardiac ICU admission. Sentrino subcutaneous glucose sensors were inserted into patients' thigh with planned study participation of 72 h. Sensor glucose results were displayed, and the system's alerts and alarms fully enabled. Reference blood glucose was collected from central venous catheter and analyzed with a blood gas analyzer. Treatment decisions were made independently of sensor glucose values, according to the existing standard of care.

RESULTS

A total of 21 patients were enrolled; all successfully completed the study. Sensor glucose values were displayed 96% of the time, and 870 paired blood glucose-sensor glucose points were analyzed. Overall mean absolute relative difference (MARD) was 12.8% (95% CI 11.9% to 13.6%). No clinically significant differences in accuracy were seen within subgroups of hemodynamic status (MARD 12.3% and 13.1% for compromised vs stable hemodynamics). Consensus grid analysis showed >99% of sensor glucose values within A/B zones. No device or study-related adverse events were reported. 100% of clinicians found Sentrino easy to use after two patients.

CONCLUSIONS

In our single-center experience, Sentrino CGM system demonstrated good accuracy and reliability, with no device-related adverse events in critically ill cardiac patients, and was easy to use and integrate in the cardiac ICU.

TRIAL REGISTRATION NUMBER

NCT01763567.

Abstract P6-07-11: Health economic impact of breast cancer index (BCI) for late disease management in patients with estrogen receptor-positive, node-negative breast cancer

Background

Several recent randomized, prospective clinical trials (MA.17, ATLAS, aTTom) have demonstrated the clinical benefit of extending endocrine therapy beyond 5 years to address the persistent risk of recurrence in patients with ER+ breast cancer. Breast Cancer Index (BCI) is a gene expression-based test that predicts overall (10y) risk of recurrence in patients with ER+, LN- breast cancer, and also informs late (post-5 year) disease management by providing information on risk of late (≥5y) recurrence, and likelihood of benefit from extended (≥5y) endocrine therapy. Previously, BCI was shown to be cost saving across a 10-year disease horizon. The current study specifically assessed the health economic benefit of BCI for late disease management, evaluating the impact of identifying patients at risk of late recurrence and those that may benefit from extended endocrine therapy.

Methods

A fact-based economic model was developed which projected the cost and effectiveness of BCI from a US third-party payer perspective in a hypothetical population of patients with ER+, LN- breast cancer who are disease free at 5 years post-diagnosis compared to standard clinical practice. Patients flowed through the model based on patterns of care and BCI data. Costs associated with endocrine therapy, toxicity, follow-up, and recurrence were modeled over 5 yrs. Model inputs were based primarily on published literature, and supplemented by interviews with disease experts and payers. Sensitivity analyses were performed around key inputs to estimate effects on the model.

Results

Use of BCI is projected to be cost saving in this population of patients that are disease-free at 5 years post-diagnosis, with a net cost savings of $691 per patient tested after accounting for BCI cost. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving extended endocrine therapy based on BCI ($4,102), and reduced recurrence in previously non-compliant patients ($39). BCI was cost saving for both pre- and post-menopausal women. Sensitivity analyses demonstrated that results were most sensitive to current use of extended endocrine therapy in postmenopausal patients, future use of extended endocrine therapy in BCI (H/I) high patients, and the percentage of patients characterized as BCI (H/I) high.

Conclusions

BCI is projected to be cost saving in a population of ER+, LN-, breast cancer patients who are recurrence free at 5 years post-diagnosis. Cost savings are achieved through projected impact on extended endocrine therapy use and endocrine therapy compliance, and provide additional cost savings beyond impact on chemotherapy utilization. These findings require validation in additional cohorts, including studies of real-world clinical practice.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-11.