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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Cancer 1/2017

Personalized treatment of women with early breast cancer: a risk-group specific cost-effectiveness analysis of adjuvant chemotherapy accounting for companion prognostic tests OncotypeDX and Adjuvant!Online

Zeitschrift:
BMC Cancer > Ausgabe 1/2017
Autoren:
Beate Jahn, Ursula Rochau, Christina Kurzthaler, Michael Hubalek, Rebecca Miksad, Gaby Sroczynski, Mike Paulden, Marvin Bundo, David Stenehjem, Diana Brixner, Murray Krahn, Uwe Siebert
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12885-017-3603-z) contains supplementary material, which is available to authorized users.

Abstract

Background

Due to high survival rates and the relatively small benefit of adjuvant therapy, the application of personalized medicine (PM) through risk stratification is particularly beneficial in early breast cancer (BC) to avoid unnecessary harms from treatment. The new 21-gene assay (OncotypeDX, ODX) is a promising prognostic score for risk stratification that can be applied in conjunction with Adjuvant!Online (AO) to guide personalized chemotherapy decisions for early BC patients. Our goal was to evaluate risk-group specific cost effectiveness of adjuvant chemotherapy for women with early stage BC in Austria based on AO and ODX risk stratification.

Methods

A previously validated discrete event simulation model was applied to a hypothetical cohort of 50-year-old women over a lifetime horizon. We simulated twelve risk groups derived from the joint application of ODX and AO and included respective additional costs. The primary outcomes of interest were life-years gained, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness (ICER). The robustness of results and decisions derived were tested in sensitivity analyses. A cross-country comparison of results was performed.

Results

Chemotherapy is dominated (i.e., less effective and more costly) for patients with 1) low ODX risk independent of AO classification; and 2) low AO risk and intermediate ODX risk. For patients with an intermediate or high AO risk and an intermediate or high ODX risk, the ICER is below 15,000 EUR/QALY (potentially cost effective depending on the willingness-to-pay). Applying the AO risk classification alone would miss risk groups where chemotherapy is dominated and thus should not be considered. These results are sensitive to changes in the probabilities of distant recurrence but not to changes in the costs of chemotherapy or the ODX test.

Conclusions

Based on our modeling study, chemotherapy is effective and cost effective for Austrian patients with an intermediate or high AO risk and an intermediate or high ODX risk. In other words, low ODX risk suggests chemotherapy should not be considered but low AO risk may benefit from chemotherapy if ODX risk is high. Our analysis suggests that risk-group specific cost-effectiveness analysis, which includes companion prognostic tests are essential in PM.
Zusatzmaterial
Additional file 1: Table S1. Model parameter overview. In the text of the manuscript, “Table S1” is referring to Table 1: “Model parameter overview”. Table 1 provides the set of input parameters that are used in the model. (DOCX 368 kb)
Additional file 2: Table S2A. Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with a low risk according to OncotypeDX. “Table S2A” is referring to Table 2a: “Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with a low risk according to OncotypeDX”. (DOCX 18 kb)
Additional file 3: Table S2B. Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with an intermediate risk according to OncotypeDX. “Table S2B” is referring to Table 2b: Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with an intermediate risk according to OncotypeDX. (DOCX 18 kb)
Additional file 4: Table S2C. Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with a high risk according to OncotypeDX. “Table S2C” is referring to Table 2c: Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups with a high risk according to OncotypeDX. (DOCX 18 kb)
Additional file 5: Table S2D. Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups where OncotypeDX is not applied. “Table S2D” is referring to Table 2d: Sensitivity Analysis of cost effectiveness of chemotherapy in subgroups where OncotypeDX is not applied. Table 2a, b, c and d show detailed results of the sensitivity analyses on the parameters age, discount rate, costs, probabilities and utilities. (DOCX 18 kb)
Literatur
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