Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study
Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study
thumbnail.default.placeholder
Tarih
2019-01-01
Yazarlar
Ozmen, Vahit
Cakar, Burcu
Gokmen, Erhan
Ozdogan, Mustafa
Guler, Nilufer
Uras, Cihan
Ok, Engin
Demircan, Orhan
Isikdogan, Abdurrahman
Saip, Pinar
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
AVES
Dergi Adı
EUROPEAN JOURNAL OF BREAST HEALTH
Özet
Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57\% had low recurrence score (RS), 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33\%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at \$3.649, and Oncotype Dx test was \$5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be \$7207.9 per QALY gained and \$5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.
Açıklama
Anahtar kelimeler
Early breast cancer, genetic profiling, oncotype-Dx, cost, markov model