Cost-utility analysis of genomic profiling in early breast cancer in Colombia

Cost Effectiveness and Resource Allocation

Research

Diego Rosselli¹  Alejandro Ruiz-Patiño²  Juan Guillermo Ariza³  María X. Rojas-Reyes⁴  Andrés F. Cardona⁵  Leonardo Rojas⁶ 

[1] Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia;Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia;Head Medical Affairs, Baxter International, Bogotá, Colombia;Institut d´Investigació Biomédica Sant Pau (IIB SANT PAU), Barcelona, Spain;Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia;Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia;Direction of Research, Science and Education, Fundación Centro de Tratamiento en Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia;Thoracic and GU Unit, Fundación Centro de Tratamiento en Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Carrera 14 # 169 -49, Office 204, Bogotá, Colombia;Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia;

关键词: Breast cancer;    Personalized medicine;    Cost-utility;   

DOI  :  10.1186/s12962-023-00449-5

 received in 2022-11-08, accepted in 2023-06-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy.MethodsThis study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed.ResultsODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and $554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was $416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy.ConclusionsGenomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 −EBC is a cost-effective strategy that allows Colombian NHS to maintain budget.

【 授权许可】

CC BY   
© The Author(s) 2023

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