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de Lima MAG, Clemons M, Van Katwyk S, Stober C, Robertson SJ, Vandermeer L, Fergusson D, Thavorn K. Cost analysis of using Magee scores as a surrogate of Oncotype DX for adjuvant treatment decisions in women with early breast cancer. J Eval Clin Pract 2020; 26:889-892. [PMID: 31287198 DOI: 10.1111/jep.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most common cancer in women worldwide. Most current guidelines recommend using multigene profiling assays to aid the decision on the addition of chemotherapy to adjuvant hormone therapy for women who present with early-stage, hormone receptor-positive, HER2-negative disease. One of these assays is the Oncotype DX, which predicts the disease recurrence risk and adjuvant chemotherapy benefits. Given its high cost, there is an economic incentive to evaluate its surrogates, such as the Magee equations. We assessed health system costs associated with the use of the Magee scores. A probabilistic decision tree was used to calculate the difference in mean health system costs based on data obtained from a randomized trial and the published literature. Costs were calculated from a perspective of Canada's publicly funded health care system. A series of sensitivity analysis was conducted to assess the robustness of the study findings. The Magee equations were associated with a total cost savings of C$100 per patient (95% CI, -C$3068 to C$5022) compared with standard of care. The difference in costs was highly sensitive to the extent that the Magee scores could reduce the frequency of adjuvant chemotherapy and Oncotype DX requests.
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Affiliation(s)
- Mariana A G de Lima
- Institute of Cancer of the State of São Paulo, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mark Clemons
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Division of Medical Oncology, Department of Medicine and University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sasha Van Katwyk
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Carol Stober
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Susan J Robertson
- Eastern Ontario Regional Laboratory Association, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Vandermeer
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dean Fergusson
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Institute of Clinical and Evaluative Sciences (ICES uOttawa), University of Ottawa, Ottawa, ON, Canada
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