Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study

Abstract

Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods:A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results:The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the costeffectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion:As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.

Systematic Review of the Cost Effectiveness of Breast Cancer Prevention, Screening, and Treatment Interventions

“…This was seen in cost-effectiveness analyses of prevention strategies for breast (and ovarian) cancer through genetic testing and preventive surgery among high-risk populations (eg, relatives of affected women, Ashkenazi or Sephardic Jewish women), [20][21][22][23][24][25][26][27] screening schedules tailored to breast cancer risk, [30][31][32]34,[39][40][41]43,45 and targeting chemotherapy to women at highest risk of distant recurrence based on genomic test results. 74,75,79,[81][82][83][84] However, health care systems would require an investment of resources, training and time of providers to identify women meeting criteria for intervention, and time for counseling of women regarding the need for the intervention. None of the targeted cancer control interventions we reviewed included these types of costs, making it difficult to fully evaluate the economic value of implementing targeted care.…”

“…Twelve articles evaluated the use of new diagnostic technology, such as gene expression profile testing to guide adjuvant treatment selection. [73][74][75][76][77][78][79][80][81][82][83][84] The majority of the studies (n = 9) evaluated the cost effectiveness of the 21-gene recurrence score assay (Oncotype DX; Genomic Health, Redwood City, CA) to select treatment. 74,75,77,[79][80][81][82][83][84] Seven of these 9 studies reported cost savings or cost-effective results for Oncotype DX testing or the incorporation of Oncotype DX test results with clinical features to guide treatment decisions in patient subgroups.…”

“…[73][74][75][76][77][78][79][80][81][82][83][84] The majority of the studies (n = 9) evaluated the cost effectiveness of the 21-gene recurrence score assay (Oncotype DX; Genomic Health, Redwood City, CA) to select treatment. 74,75,77,[79][80][81][82][83][84] Seven of these 9 studies reported cost savings or cost-effective results for Oncotype DX testing or the incorporation of Oncotype DX test results with clinical features to guide treatment decisions in patient subgroups. 74,75,81,83,84 For example, Kip et al 75 found costs of V11,236 per QALY for using Oncotype DX testing to support adjuvant chemotherapy recommendations, compared with current clinical practice, in the Netherlands.…”

“…74,75,77,[79][80][81][82][83][84] Seven of these 9 studies reported cost savings or cost-effective results for Oncotype DX testing or the incorporation of Oncotype DX test results with clinical features to guide treatment decisions in patient subgroups. 74,75,81,83,84 For example, Kip et al 75 found costs of V11,236 per QALY for using Oncotype DX testing to support adjuvant chemotherapy recommendations, compared with current clinical practice, in the Netherlands. However, Chandler et al 80 reported $188,125 per QALY for Oncotype DX testing (v usual care) based on observed community testing patterns and actual test properties in the United States.…”

Mathematical Models in Healthcare

“…76,77 Kronik hastalıklar için bir çalışmada meme kanseri Markov modeli ile karar ağacı birleştirilerek uygulanmış ve erken dönem kanser hastalarında gen testi uygulanmasının maliyet-etkililiği araştırılmıştır. 78 Benzer bir çalışma, akciğer kanserinde kemoterapi ilaçları arasında maliyet açısından seçim yapmayı sağlamak adına Markov bazlı bir model oluşturmuştur. 79 Diyabet için oluşturulan bir modelle sigara ve obezite göz önüne alınarak 2025'e kadar prevalans tahmininde bulunulmuştur.…”