Meta-Analysis of Decision Impact and Net Decision Change in Adjuvant Chemotherapy Allocation in Early Stage Node-Negative, Estrogen Receptor-Positive Breast Cancer with a 21-Gene Assay

Abstract

BAckground: Cancer is one of the most prevalent diseases in the UK with over 300,000 cases every year, with breast cancer being the most common cause of death for adults aged 35-64.48% of all diagnosed with cancer die within 5 years. Cancer puts huge cost pressure on NHS resources. Multi-staged drug therapies involve the use of drugs to either slow down the proliferation of cancer cells or kill them, with variable success. The new innovative drugs are deemed to be too expensive for the limited benefit they may offer as the cancer may have reached terminal stage, after an already expensive overall course of therapy. oBjectives: to perform a systematic review and meta-analysis to investigate whether the drug cost is the main driver for the high Incremental Cost utility ratios. Methods: Systematic review and meta-analysis were performed to answer the research question. The search was concentrated to the drugs of the three most common cancers in the UK (breast, lung and prostate). Cardiff search database was used to perform the search. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of reviews. PRISMA checklist was used by the author to undertake the meta-analysis. results: 146 publications were retrieved. Final number of publications included went down to 14 [The PRISMA scoring for 71% of them (10 publications) were 21-24/27]. From which 25 cost effectiveness studies were extracted. Not every oncology drug showed high ICER (above £30 000), only 10 studies (45% of the publications), which contradicts the common perception about ICERs of oncology. More surprisingly was that eight (80%) of the 10 studies showed moderate cost per treatment. conclusions: Cost of drug treatments is not the main driver for the high ICER (P-value: 0.982) but it is one of many that heavily impact the ICER value.