Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

BMC Cancer

Research Article

Lisanne S. Rigter¹  Anna Miquel-Cases²  Wim H. van Harten³  Lotte M. G. Steuten⁴ 

[1] Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands;Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands;Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands;Department of Healthcare Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands;Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, P.O. Box 19024, 1100 Fairview Ave. N., Seattle, USA;

关键词: Cost-effectiveness;    Resource utilization;    Breast cancer;    Neoadjuvant chemotherapy;    Response monitoring;    MRI;   

DOI  :  10.1186/s12885-016-2653-y

 received in 2015-08-14, accepted in 2016-07-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundResponse-guided neoadjuvant chemotherapy (RG-NACT) with magnetic resonance imaging (MRI) is effective in treating oestrogen receptor positive/human epidermal growth factor receptor-2 negative (ER-positive/HER2-negative) breast cancer. We estimated the expected cost-effectiveness and resources required for its implementation compared to conventional-NACT.MethodsA Markov model compared costs, quality-adjusted-life-years (QALYs) and costs/QALY of RG-NACT vs. conventional-NACT, from a hospital perspective over a 5-year time horizon. Health services required for and health outcomes of implementation were estimated via resource modelling analysis, considering a current (4 %) and a full (100 %) implementation scenario.ResultsRG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94 % (current) and 95 % (full) certainty, at a willingness to pay threshold of €20.000/QALY. Fully implementing RG-NACT in the Dutch target population of 6306 patients requires additional 5335 MRI examinations and an (absolute) increase in the number of MRI technologists, by 3.6 fte (full-time equivalent), and of breast radiologists, by 0.4 fte. On the other hand, it prevents 9 additional relapses, 143 cancer deaths, 23 congestive heart failure events and 2 myelodysplastic syndrome/acute myeloid leukaemia events.ConclusionConsidering cost-effectiveness, RG-NACT is expected to dominate conventional-NACT. While personnel capacity is likely to be sufficient for a full implementation scenario, MRI utilization needs to be intensified.

【 授权许可】

CC BY   
© The Author(s). 2016

【 图 表 】

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