Cost–utility analyses of drug therapies in breast cancer: a systematic review

Abstract

The economic evaluation (EE) of health care products has become a necessity. Their quality must be high in order to trust the results and make informed decisions. While cost-utility analyses (CUAs) should be preferred to cost-effectiveness analyses in the oncology area, the quality of breast cancer (BC)-related CUA has been given little attention so far. Thus, firstly, a systematic review of published CUA related to drug therapies for BC, gene expression profiling, and HER2 status testing was performed. Secondly, the quality of selected CUA was assessed and the factors associated with a high-quality CUA identified. The systematic literature search was conducted in PubMed, MEDLINE/EMBASE, and Cochrane to identify published CUA between 2000 and 2014. After screening and data extraction, the quality of each selected CUA was assessed by two independent reviewers, using the checklist proposed by Drummond et al. The analysis of factors associated with a high-quality CUA (defined as a Drummond score ≥7) was performed using a two-step approach. Our systematic review was based on 140 CUAs and showed a wide variety of methodological approaches, including differences in the perspective adopted, the time horizon, measurement of cost and effectiveness, and more specially health-state utility values (HSUVs). The median Drummond score was 7 [range 3-10]. Only one in two of the CUA (n = 74) had a Drummond score ≥7, synonymous of "high quality." The statistically significant predictors of a high-quality CUA were article with "gene expression profiling" topic (p = 0.001), consulting or pharmaceutical company as main location of first author (p = 0.004), and articles with both incremental cost-utility ratio and incremental cost-effectiveness ratio as outcomes of EE (p = 0.02). Our systematic review identified only 140 CUAs published over the past 15 years with one in two of high quality. It showed a wide variety of methodological approaches, especially focused on HSUVs. A critical appraisal of utility values is necessary to better understand one of the main difficulties encountered by authors and propose areas for improvement to increase the quality of CUA. Since the last 5 years, there is a tendency toward an improvement in the quality of these studies, probably coupled with economic context, a better and widely spreading of recommendations and thus appropriation by medical practitioners. That being said, there is an urgent need for mandatory use of European and international recommendations to ensure quality of such approaches and to allow easy comparison.

Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review

“…There were four categories of reviews of economic evaluations: test and treat interventions across disease areas or technology ( n = 13); test and treat interventions in a specific disease area of technology ( n = 17); diagnostic-only interventions across disease areas or technologies ( n = 9); and diagnostic-only interventions in a specific disease or technology area ( n = 6). The size of the reviews ranged from zero included papers, for a review of evaluation of genetic diagnosis of aneuploidy in all chromosomes [38], to 140 papers for a review of economic evaluations of targeted and non-targeted therapies for breast cancer [39].…”

A systematic review of economic evaluation in fecal microbiota transplantation

“…As previously described, using the Drummond checklist as a scoring system has the advantage of allowing a comparison between different EEs and their results; thus, it is more objective and provides a way to measure the transferability of an EE and its results. 39,41,42 However, as with any rating scale, a major limitation of the Drummond checklist is the likelihood of bias, even when the interobserver variability between reviewers is good. 43,44 Thus, the quality assessment of each selected CUA was performed by 2 independent reviewers (S.D.…”

Neoadjuvant Management of Early Breast Cancer: A Clinical and Investigational Position Statement

“…In some homogeneous subsets of cases, however, economic analysis may be reasonable. From 2000 to 2015, several studies were published evaluating the cost‐effectiveness of drugs, of which only three were in the neoadjuvant setting (37 drugs were in the metastatic setting, and 101 were in the adjuvant setting) . A substantial number of these studies have focused on HER2‐positive breast cancer.…”