<p>Analysis of the Cost-Effectiveness of Liquid Biopsy to Determine Treatment Change in Patients with Her2-Positive Advanced Breast Cancer in Colombia</p>

Abstract

Background: Breast cancer is highly prevalent worldwide and leads to high health-care costs. HER2-positive subtype represents 30% of all breast cancers and is associated with a poor prognosis. Patients treated with anti-HER2 therapies frequently develop resistance and require pharmacological treatment change. Liquid biopsy is a minimally invasive and an easily accessible technique, with high sensitivity and specificity, to detect molecular treatment resistance even before the onset of clinical manifestations and can thus be used to reduce unnecessary anti-HER2 treatment costs. Objective: To evaluate the cost-effectiveness of using liquid biopsy (ctDNA detection) to determine treatment change in women with HER2-positive advanced breast cancer in Colombia. Methodology: We performed an economic evaluation using decision tree modeling and deterministic analyses based on literature search for first and second lines of treatment (trastuzumab, pertuzumab, docetaxel, and TDM1); resistance; outcomes; and sensitivity and specificity of tests detecting molecular resistance. The effectiveness was measured using quality-adjusted life year (QALY) score, and costs were obtained from databases with national validity, suppliers, the Colombian Drug Price Information System (SISMED), and local studies. Results: The use of liquid biopsy (ctDNA detection) with conventional treatment was more expensive and less effective than conventional treatment without liquid biopsy (US $177,985.35 and 0.533889206 QALY, respectively). The incremental cost with liquid biopsy was US $7,333.17 and the incremental effectiveness was 0.00042256 QALY relative to the conventional method. Conclusion: Including liquid biopsy in the treatment of HER2-positive advanced breast cancer was considered currently inapplicable in Colombia because it was not cost effective. Our results open a window of opportunity to improve the development and implementation of ctDNA testing in Colombia, potentially reducing current costs. More evidence is required on the utility of this test, depending on the financial capacity of Colombia and other countries.

NGS in Lung, Breast, and Unknown Primary Cancer in Colombia: A Multidisciplinary Consensus on Challenges and Opportunities

“… 33 - 36 In 2018, approximately 13,400 new BC cases were diagnosed in Colombia (44.1 per 100,000 inhabitants), representing 13.1% of total cancer diagnoses. 37 These figures reflect deficiencies in screening, diagnosis, and treatment. 38 …”

Recent advances in aptamer applications for analytical biochemistry

“…According to a 2018 review by Perrier et al [ 101 ], overexpression of epidermal growth factor receptor HER2, a transmembrane protein, is associated with an aggressive form of breast cancer and a poor clinical prognosis. Consequently, HER2 is considered to be an informative and actionable biomarker for monitoring breast cancer [ 102 ].…”

Microfluidic Approaches and Methods Enabling Extracellular Vesicle Isolation for Cancer Diagnostics

“…Consequently, the main analytical targets in liquid biopsies include extracellular vesicles (EVs), circulating nucleic acids, and circulating tumor cells (CTCs) [16]. Liquid biopsies may provide additional potential benefits due to relatively low cost [17,18], being minimally invasive [19,20], and providing the opportunity for detailed molecular profiles of tumor-derived materials shed into a variety of biofluids, such as blood [21], urine [22], saliva [23], and cerebrospinal fluid (CSF) [24,25].…”