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Martins-Branco D, Cristóvão Ferreira S, Gouveia E, André S, Esteves S, Brito M, Moreira A. Adjuvant Chemotherapy De-Escalation with Genomic Assay Protocol in Patients with Early Breast Cancer: A Single-Centre Prospective Cohort Study. ACTA MEDICA PORT 2023. [PMID: 36745867 DOI: 10.20344/amp.18539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/14/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Genomic assays are useful tools for tailoring adjuvant treatment in early breast cancer. We aimed to analyse the role of an institutional protocol of a genomic assay for chemotherapy de-escalation. MATERIAL AND METHODS Prospective cohort study of all consecutive women diagnosed with hormone receptor-positive and human epidermal growth factor receptor 2-negative early breast cancer, tested with the 21-gene Recurrence Score (RS) assay from August 2015 to July 2018 at a Portuguese cancer centre. For being tested, patients should meet at least one of the pre-defined inclusion criteria: i) luminal A-like, pT2pN0; ii) luminal A-like, 1 - 3 positive nodes and comorbidities with higher risk of chemotherapy-induced toxicity; iii) pT1-2pN0, progesterone receptor ≤ 20% and/or Ki67 14% - 40%. Adjuvant treatment was de-escalated to isolated endocrine therapy if RS was less than 18. We measured the reduction in chemotherapy prescribing and its clinical impact, the RS association with pathologic features, and the protocol feasibility. RESULTS We tested 154 women with a median age of 61 years old (range: 25 - 79), 69% postmenopausal. Tumours were mainly pT1 (55%), pN0 (82%), invasive ductal (73%), G2 (86%), luminal B-like (69%) and stage IA (85%). We obtained a RS less than 18 in 60% of women, with an overall adjuvant chemotherapy reduction of 65%. Seven (95% confidence interval: 5 - 10) patients needed to be screened with the 21-gene RS assay to prevent one clinically relevant adverse event during the first six months of adjuvant treatment. Considering the currently used RS cut-off, only 9% of node-negative and 11% of node-positive patients had RS over 25. We found no relevant associations between RS and pathologic features. The protocol was feasible and did not compromise the adequate timing for adjuvant treatment. CONCLUSION These criteria allowed the de-escalation of adjuvant systemic treatment in at least six out of ten women.
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Affiliation(s)
- Diogo Martins-Branco
- Breast Multidisciplinary Clinic. Medical Oncology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Sofia Cristóvão Ferreira
- Breast Multidisciplinary Clinic. Medical Oncology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Emanuel Gouveia
- Breast Multidisciplinary Clinic. Medical Oncology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Saudade André
- Breast Multidisciplinary Clinic. Pathology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Susana Esteves
- Clinical Research Unit. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - Margarida Brito
- Breast Multidisciplinary Clinic. Medical Oncology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
| | - António Moreira
- Breast Multidisciplinary Clinic. Medical Oncology. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisbon. Portugal
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Jubair S, Alkhateeb A, Tabl AA, Rueda L, Ngom A. A novel approach to identify subtype-specific network biomarkers of breast cancer survivability. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s13721-020-00249-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wang SY, Dang W, Richman I, Mougalian SS, Evans SB, Gross CP. Cost-Effectiveness Analyses of the 21-Gene Assay in Breast Cancer: Systematic Review and Critical Appraisal. J Clin Oncol 2018; 36:1619-1627. [PMID: 29659329 DOI: 10.1200/jco.2017.76.5941] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Prior studies examining cost effectiveness of the 21-gene assay (Oncotype DX [ODX]) for women with hormone receptor-positive, early-stage breast cancer have yielded disparate results. We aimed to explore why these analyses may have yielded different conclusions. Methods We conducted a systematic literature review of cost-effectiveness analyses (CEAs) of ODX. We examined the extent to which the structure of CEA modeling, the assumptions of the models, and the selection of input parameters influenced cost-effectiveness estimates. We also explored the prevalence of industry funding and whether industry funding was associated with study designs favoring ODX. Results We identified 27 analyses, 15 of which received industry funding. In 18 studies, the clinical characteristics (eg, tumor size and grade) commonly used to make chemotherapy decisions were not incorporated into simulation modeling; thus, these studies would favor ODX being cost effective and might not reflect clinical practice. Most studies ignored the heterogeneous effect of ODX on chemotherapy use; only five studies assumed that ODX would increase chemotherapy use for clinically low-risk patients but decrease chemotherapy use for clinically high-risk patients. No study used population-based joint distributions of ODX recurrence score and tumor characteristics, and 12 studies inappropriately assumed that chemotherapy would increase distant recurrence for the low recurrence score group; both approaches overestimated the benefits of ODX. Industry-funded studies tended to favor ODX; all five studies that reported ODX as being cost saving were industry funded. In contrast, two studies that reported an incremental cost-effectiveness ratio > $50,000 per quality-adjusted life-year were not funded by industry. Conclusion Although a majority of published analyses indicated that ODX is cost effective, they incorporated study designs that can increase the risk of bias.
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Affiliation(s)
- Shi-Yi Wang
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
| | - Weixiong Dang
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
| | - Ilana Richman
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
| | - Sarah S Mougalian
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
| | - Suzanne B Evans
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
| | - Cary P Gross
- Shi-Yi Wang and Weixiong Dang, Yale University School of Public Health; Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale Cancer Center; and Shi-Yi Wang, Ilana Richman, Sarah S. Mougalian, Suzanne B. Evans, and Cary P. Gross, Yale University School of Medicine, New Haven, CT
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Lobo JM, Trifiletti DM, Sturz VN, Dicker AP, Buerki C, Davicioni E, Cooperberg MR, Karnes RJ, Jenkins RB, Den RB, Showalter TN. Cost-effectiveness of the Decipher Genomic Classifier to Guide Individualized Decisions for Early Radiation Therapy After Prostatectomy for Prostate Cancer. Clin Genitourin Cancer 2017; 15:e299-e309. [DOI: 10.1016/j.clgc.2016.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 01/09/2023]
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Lynch JA, Berse B, Petkov V, Filipski K, Zhou Y, Khoury MJ, Hassett M, Freedman AN. Implementation of the 21-gene recurrence score test in the United States in 2011. Genet Med 2016; 18:982-90. [PMID: 26890451 DOI: 10.1038/gim.2015.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/17/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE We examined hospital use of the 21-gene breast cancer test in the United States. We report state-level differences in utilization and propose a model for predicting implementation of guideline-recommended genomic testing. METHODS Genomic Health provided test orders for calendar year 2011.We summarized utilization at the hospital and state levels. Using logistic regression, we analyzed the association between the likelihood to order the test and the hospital's institutional and regional characteristics. RESULTS In 2011, 45% of 4,712 acute-care hospitals ordered the test, which suggests that 25% of newly diagnosed invasive female breast cancer cases were tested. Significant predictors of testing included participation in National Cancer Institute (NCI) clinical research cooperative groups (odds ratio (OR) 3.73; 95% confidence interval, 2.96-4.70), advanced imaging (OR, 2.19; CI, 1.78-2.68), high-complexity laboratory (OR, 2.15; CI, 1.24-3.70), affiliation with a medical school (OR, 1.57; CI, 1.31-1.88), and reconstructive surgery (OR, 1.23; CI, 1.01-1.50). Significant regional predictors included metropolitan county (OR, 3.77; CI, 2.83-5.03), above-mean income (OR, 1.37; CI, 1.11-1.69), and education (OR, 1.26; CI, 1.03-1.54). Negative predictors included designation as a critical-access hospital (OR, 0.10; CI, 0.07-0.14) and distance from an NCI cancer center (OR, 0.998; CI, 0.997-0.999), with a 15% decrease in likelihood for every 100 miles. CONCLUSION Despite considerable market penetration of the test, there are significant regional and site-of-care differences in implementation, particularly in rural states.Genet Med 18 10, 982-990.
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Affiliation(s)
- Julie A Lynch
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Brygida Berse
- RTI International, Research Triangle Park, Durham, North Carolina, USA.,Boston University School of Medicine, Boston, Massachusetts, USA.,Veterans Health Administration, Bedford, Massachusetts, USA
| | - Valentina Petkov
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kelly Filipski
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yingjun Zhou
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemiology and Genomics Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Hassett
- Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew N Freedman
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Recommendations from the EGAPP Working Group: does the use of Oncotype DX tumor gene expression profiling to guide treatment decisions improve outcomes in patients with breast cancer? Genet Med 2015; 18:770-9. [PMID: 26681310 DOI: 10.1038/gim.2015.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/21/2015] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED of RECOMMENDATIONS The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group found insufficient evidence to recommend for or against the use of Oncotype DX testing to guide chemotherapy treatment decisions in women with hormone receptor-positive, lymph node-negative, or lymph node-positive early breast cancer who are receiving endocrine therapy. This recommendation statement updates a 2009 EGAPP statement on the use of gene expression profiling tests in breast cancer. Evidence of clinical validity for Oncotype DX was confirmed as adequate. With regard to clinical utility, although there was evidence from prospective retrospective studies that the Oncotype DX test predicts benefit from chemotherapy, and there was adequate evidence that the use of Oncotype DX gene expression profiling in clinical practice changes treatment decisions regarding chemotherapy, no direct evidence was found that the use of Oncotype DX testing leads to improved clinical outcomes. RATIONALE In women with early-stage invasive breast cancer, gene expression profiling is increasingly being used as an aid to estimate the likely benefit from chemotherapy treatment. In a previous recommendation statement, the EGAPP Working Group (EWG) found adequate evidence for clinical validity of some gene expression profiling tests in predicting distant disease recurrence in women with early-stage, hormone receptor-positive, lymph-node-negative breast cancer who are treated with tamoxifen, but insufficient evidence that use of these tests for decisions about chemotherapy treatment has clinical utility. The current recommendation statement updates these findings for Oncotype DX and extends them to the population of women with lymph node-positive disease, using evidence from recent systematic reviews and other sources. ANALYTIC VALIDITY The previous recommendation statement found that evidence was inadequate to enable quantitative determination of the analytic validity of Oncotype DX. Analytic validity was not reconsidered in the updated recommendation statement because there remains no gold-standard test for comparison. CLINICAL VALIDITY The EWG found that new evidence published since the original evidence review supports the clinical validity of Oncotype DX in predicting risk of distant metastases in women with hormone receptor-positive, early-stage breast cancer that is either node-negative or node-positive. CLINICAL UTILITY No direct evidence was found that use of Oncotype DX tumor gene expression profiling to guide treatment decisions improves clinical outcomes in women with early breast cancer. There is indirect evidence, from prospective retrospective studies on archived tissue samples from randomized controlled trials, that the Oncotype DX test can predict benefit from chemotherapy. Large, prospective, randomized, controlled trials currently in progress may provide evidence of clinical utility. CONTEXTUAL ISSUES Until definitive evidence for clinical utility is available, clinicians must decide on a case-by-case basis whether to offer the test to patients. Although Oncotype DX testing has been reported, on the basis of economic modeling studies, to be cost-effective in several different health-care systems and to save costs in the US health-care setting, studies were based on assumptions regarding the clinical utility of the test that require confirmation by clinical trial results.Genet Med 18 8, 770-779.
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Epstein AJ, Wong YN, Mitra N, Vachani A, Hin S, Yang L, Smith-McLallen A, Armstrong K, Groeneveld PW. Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer. J Clin Oncol 2015; 33:4259-67. [PMID: 26598749 DOI: 10.1200/jco.2015.61.9023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We assessed the associations between the 21-gene recurrence score assay (RS) receipt, subsequent chemotherapy use, and medical expenditures among patients with early-stage breast cancer. PATIENTS AND METHODS Data from the Pennsylvania Cancer Registry were used to assemble a retrospective cohort of women with early-stage breast cancer from 2007 to 2010 who underwent initial surgical treatment. These data were merged with administrative claims from the 12-month periods before and after diagnosis to identify comorbidities, treatments, and expenditures (n = 7,287). Propensity score-weighted regression models were estimated to identify the effects of RS receipt on chemotherapy use and medical spending in the year after diagnosis. RESULTS The associations between RS receipt and outcomes varied markedly by patient age. RS use was associated with lower chemotherapy use among women younger than 55 (19.2% lower; 95% CI, 10.6 to 27.9). RS use was associated with higher chemotherapy use among women 75 to 84 years old (5.7% higher; 95% CI, 0.4 to 11.0). RS receipt was associated with lower adjusted 1-year medical spending among women younger than 55 ($15,333 lower; 95% CI, $2,841 to $27,824) and with higher spending among women who were 75 to 84 years old ($3,489 higher; 95% CI, $857 to $6,122). CONCLUSION RS receipt was associated with reduced use of adjuvant chemotherapy and lower health care spending among women with breast cancer who were younger than 55. Conversely, among women 75 and older, RS testing was associated with a modest increase in chemotherapy use and slightly higher spending. From a population perspective, the impact of RS testing on breast cancer treatment and health care costs is much greater in younger women.
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Affiliation(s)
- Andrew J Epstein
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Yu-Ning Wong
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Nandita Mitra
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Anil Vachani
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Sakhena Hin
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Lin Yang
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Aaron Smith-McLallen
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Katrina Armstrong
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Peter W Groeneveld
- Andrew J. Epstein and Peter W. Groeneveld, Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center; Andrew J. Epstein, Yu-Ning Wong, Nandita Mitra, Anil Vachani, Sakhena Hin, Lin Yang, and Peter W. Groeneveld, University of Pennsylvania; Yu-Ning Wong, Temple University Health System; Aaron Smith-McLallen, Independence Blue Cross, Philadelphia, PA; Katrina Armstrong, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
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Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland. Breast Cancer Res Treat 2015; 153:573-82. [PMID: 26364296 DOI: 10.1007/s10549-015-3555-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 12/21/2022]
Abstract
The 21-gene test is a validated multi-gene diagnostic test that predicts chemotherapy (CT) benefit in oestrogen receptor positive (ER+), lymph node-negative (N0) breast cancer (BC) patients (pts). Ireland was the first public health care system to reimburse this test in Europe. Study objectives were to assess the impact of this test on decision-making and to analyse the economic impact of testing. Between October 2011 and February 2013, a national, retrospective, cross-sectional observational study of ER+, N0 BC pts tested with the 21-gene test was conducted. Surveyed breast medical oncologists, provided the assumption for the decision impact analysis that grade (G) 1 pts would not have received CT before testing and G2/3 pts would have received CT before testing. Descriptive statistical analyses were performed. 592 pts were identified; Low, intermediate and high recurrence score were identified in 53, 36 and 10 % pts, respectively. 384 (70 %) pts had G2, 129 (22 %) G3 and 76 (13 %) G1 tumours. Post testing, 345 pts (59 %) experienced a change in CT decision; 339 changed to hormone therapy alone and 6 advised to receive CT. 172 (30 %) pts received CT, 12 (3.9 %) of pts with low scores, 108 (50.9 %) of intermediate risk and 50 (90.9 %) of pts with high risk scores. Net reduction in CT use was 58 % and net savings achieved were €793,565. Since public reimbursement, the introduction of the 21-gene test has resulted in a significant reduction in chemotherapy administration and cost savings for the Irish public healthcare system.
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Kip M, Monteban H, Steuten L. Long-term cost-effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective. J Comp Eff Res 2015; 4:433-45. [PMID: 25872415 DOI: 10.2217/cer.15.18] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION This study analyzes the incremental cost-effectiveness of Oncotype DX(®) testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER(+)), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The Netherlands. METHODS Markov model projecting distant recurrence, survival, quality-adjusted life years (QALYs) and healthcare costs over a 30-year time horizon. RESULTS Oncotype DX was projected to increase QALYs by 0.11 (0.07-0.58) and costs with €1236 (range: -€142-€1236) resulting in an incremental cost-effectiveness ratio of €11,236/QALY under the most conservative scenario. CONCLUSION Reallocation of adjuvant chemotherapy based on Oncotype DX testing is most likely a cost-effective use of scarce resources, improving long-term survival and QALYs at marginal or lower costs.
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Affiliation(s)
- Michelle Kip
- Panaxea BV, Health Economics & Reimbursement, Enschede, The Netherlands.,Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | | | - Lotte Steuten
- Panaxea BV, Health Economics & Reimbursement, Enschede, The Netherlands.,Hutchinson Institute for Cancer Outcomes Research (HICOR), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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