Genomic profile of breast cancer: cost–effectiveness analysis from the Spanish National Healthcare System perspective

Seguí, Miguel Àngel; Crespo, C.; Cortés, Javier; Lluch, Aña; Brosa, Max; Becerra, Virginia; Chiavenna, Sebastián; Gracia, Alfredo

doi:10.1586/14737167.2014.957185

Cited by 18 publications

(8 citation statements)

References 41 publications

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“…Budget impact was mentioned in terms of the specific treatment or associated testing and how this may potentially inhibit the uptake and use of these interventions in clinical practice. Three studies focused on the budget impact in broad terms [41–43], but a further ten studies specified the discussion about the financial impact of testing or treatment [42, 44–52].…”

Section: Resultsmentioning

confidence: 99%

“…However, clinical practice is complex and the way in which a test fits into the current care pathway is not always clear. Nine studies highlighted issues with the transition of tests from research to clinical settings [41, 42, 54, 55, 60–64]. For example, Breijer et al [61] developed and evaluated two multivariable models to produce an algorithm to predict the risk of endometrial cancer based on patients’ characteristics.…”

Section: Resultsmentioning

confidence: 99%

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

2019

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Background and Objective Precision (stratified or personalised) medicine is underpinned by the premise that it is feasible to identify known heterogeneity using a specific test or algorithm in patient populations and to use this information to guide patient care to improve health and well-being. This study aimed to understand if, and how, previous economic evaluations of precision medicine had taken account of the impact of capacity constraints. Methods A meta-review was conducted of published systematic reviews of economic evaluations of precision medicine (test–treat interventions) and individual studies included in these reviews. Due to the volume of studies identified, a sample of papers published from 2007 to 2015 was collated. A narrative analysis identified whether potential capacity constraints were discussed qualitatively in the studies and, if relevant, which quantitative methods were used to account for capacity constraints. Results A total of 45 systematic reviews of economic evaluations of precision medicine were identified, from which 222 studies focusing on test–treat interventions, published between 2007 and 2015, were extracted. Of these studies, 33 (15%) qualitatively discussed the potential impact of capacity constraints, including budget constraints; quality of tests and the testing process; ease of use of tests in clinical practice; and decision uncertainty. Quantitative methods (nine studies) to account for capacity constraints included static methods such as capturing inefficiencies in trials or models and sensitivity analysis around model parameters; and dynamic methods, which allow the impact of capacity constraints on cost effectiveness to change over time. Conclusions Understanding the cost effectiveness of precision medicine is necessary, but not sufficient, evidence for its successful implementation. There are currently few examples of evaluations that have quantified the impact of capacity constraints, which suggests an area of focus for future research. Electronic supplementary material The online version of this article (10.1007/s40273-019-00801-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

2019

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“…On the basis of pivotal clinical trials of CDK4/6 inhibitors (MONALEESA-2 and PALOMA-2), 8 , 12 average age was 62 years, with an estimated mean body surface of 1.7 m 2 . 13 , 14 …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2– advanced or metastatic breast cancer in Spain

Galve-Calvo

González-Haba

Gostkorzewicz

et al. 2018

CEOR

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PurposeThe aim of this study was to evaluate the cost-effectiveness of ribociclib compared to palbociclib, both in combination with letrozole, in the first-line treatment of postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer (ABC) from the perspective of the Spanish National Health System (NHS).Patients and methodsDisease progression was simulated with a partitioned survival model developed from the parameterization and extrapolation of survival curves of postmenopausal women with HR+/HER2− ABC from clinical trials with ribociclib or palbociclib, both in combination with letrozole. The model was structured on the basis of three health states (progression-free, progressed disease, and death), with a 1-month cycle length and inclusion of subsequent treatments administered for disease progression, over a time horizon of 15 years. Clinical, economic, and quality of life parameters were drawn from clinical trials and the literature. The use of resources and clinical practice in the Spanish setting was validated by a panel of experts. The Spanish NHS perspective was adopted, taking into account exclusively direct health costs from 2017 expressed in Euros. Drug prices used were the reported ex-factory prices. Uncertainty of the parameters and robustness of the results were evaluated using deterministic and probabilistic sensitivity analyses (2,000 iterations).ResultsThis cost-effectiveness analysis showed a greater benefit (0.437 and 0.285 life-years gained [LYGs] and quality-adjusted life years [QALYs] gained, respectively) and a slightly higher cost (€439.86) for ribociclib+letrozole compared to palbociclib+letrozole. The resulting incremental cost-effectiveness and cost-utility ratios were €1,007.69 per LYG and €1,543.62 per QALY gained, respectively. The results of the multiple sensitivity analyses showed limited dispersion of the outcomes, thus corroborating their robustness.ConclusionFrom the NHS perspective, considering the most commonly established willingness-to-pay thresholds in the Spanish setting, ribociclib+letrozole would represent a cost-effective therapeutic option compared to palbociclib+letrozole in the first-line treatment of HR+/HER2− ABC in postmenopausal women.

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“…Furthermore, just like the studies that used monitoring data, all economic evaluations were performed after development. Seven studies reported increased effects , 88 , 90–93 , 96 , 97 and 6 studies reported that use of analytics would increase costs. 90 , 93–95 , 97 , 98 All but 1 study included the costs of the analytics or the test in which the analytics were implemented.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported increased effects , 88 , 90–93 , 96 , 97 and 6 studies reported that use of analytics would increase costs. 90 , 93–95 , 97 , 98 All but 1 study included the costs of the analytics or the test in which the analytics were implemented. 89 Moreover, unlike the other categories, several papers discussed price thresholds at which the analytics or the test would be cost-neutral or dominant (ie, more effects and lower costs) or thresholds at which the analytics or test would be cost-effective (ie, where the incremental cost-effectiveness ratio would be below a specific cost-effectiveness threshold).…”

Section: Resultsmentioning

confidence: 99%

Economic evaluations of big data analytics for clinical decision-making: a scoping review

Bakker

Aarts

Groot

et al. 2020

Journal of the American Medical Informatics Association

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Abstract Objective Much has been invested in big data analytics to improve health and reduce costs. However, it is unknown whether these investments have achieved the desired goals. We performed a scoping review to determine the health and economic impact of big data analytics for clinical decision-making. Materials and Methods We searched Medline, Embase, Web of Science and the National Health Services Economic Evaluations Database for relevant articles. We included peer-reviewed papers that report the health economic impact of analytics that assist clinical decision-making. We extracted the economic methods and estimated impact and also assessed the quality of the methods used. In addition, we estimated how many studies assessed “big data analytics” based on a broad definition of this term. Results The search yielded 12 133 papers but only 71 studies fulfilled all eligibility criteria. Only a few papers were full economic evaluations; many were performed during development. Papers frequently reported savings for healthcare payers but only 20% also included costs of analytics. Twenty studies examined “big data analytics” and only 7 reported both cost-savings and better outcomes. Discussion The promised potential of big data is not yet reflected in the literature, partly since only a few full and properly performed economic evaluations have been published. This and the lack of a clear definition of “big data” limit policy makers and healthcare professionals from determining which big data initiatives are worth implementing.

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Genomic profile of breast cancer: cost–effectiveness analysis from the Spanish National Healthcare System perspective

Abstract: Background: Cost-effectiveness analysis of MammaPrint ® in the diagnosis of early breast cancer.Material and methods: Markov model assuming a cohort of 60-year-old women with breast cancer. Treatment costs and effects were assessed by comparing the 5-year,

Cited by 18 publications

References 41 publications

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

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

Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2– advanced or metastatic breast cancer in Spain

Economic evaluations of big data analytics for clinical decision-making: a scoping review

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Genomic profile of breast cancer: cost–effectiveness analysis from the Spanish National Healthcare System perspective

Abstract: Background: Cost-effectiveness analysis of MammaPrint ® in the diagnosis of early breast cancer.Material and methods: Markov model assuming a cohort of 60-year-old women with breast cancer. Treatment costs and effects were assessed by comparing the 5-year,

Cited by 18 publications

References 41 publications

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

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

Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2&ndash; advanced or metastatic breast cancer in Spain

Economic evaluations of big data analytics for clinical decision-making: a scoping review

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Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2– advanced or metastatic breast cancer in Spain