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Eur J Cancer. 2013 Dec;49(18):3773-9. doi: 10.1016/j.ejca.2013.08.001. Epub 2013 Aug 27.

Prospective cost-effectiveness analysis of genomic profiling in breast cancer.

Author information

1
Netherlands Cancer Institute (NKI-AVL), Department of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

The cost-effectiveness of the 70-gene signature (70-GS) (MammaPrint®) has earlier been estimated using retrospective validation data. Based on the prospective 5-year survival data of the microarRAy-prognoSTics-in-breast-cancER (RASTER) study, the aim here was to evaluate the cost-effectiveness reflecting the actual use in clinical practice, including reality-based compliance rates.

METHODS:

Costs and outcomes (quality-adjusted-life-years (QALYs)) were calculated in node-negative (N-) patients included in the RASTER study (n=427). Sensitivity and specificity of the 70-gene and Adjuvant! Online (AO) were based on 5-year distant-disease-free survival (DDFS). Subgroup analyses were performed for two groups for whom benefit of the 70-gene had earlier been reported: (1) ductal, oestrogen receptor-positive (ER+), tumour diameter 10-30 mm, grade II, age 40-70; (2) ductal, oestrogen receptor-positive, tumour diameter 5-30 mm, grade II/III and age 40-70.

RESULTS:

Based on 5-year survival data, the cost-effectiveness of the 70-gene signature versus AO was prospectively confirmed. The total health care costs per patient were €26,786 for the 70-gene and €29,187 for AO. The quality adjusted life years yielded 12.49 and 11.88, respectively. The subgroups retrieved slightly higher life gains and higher costs, but all resulted finally in a favourable position for the 70-gene signature.

CONCLUSIONS:

The use of the 70-gene signature, as judged appropriate by doctors and patients and supported by a low risk 70-gene signature as an oncological safe choice, was also found to be cost-effective.

KEYWORDS:

Adjuvant systemic treatment; Breast cancer; Gene expression profiling; Real world cost-effectiveness

PMID:
23992641
DOI:
10.1016/j.ejca.2013.08.001
[Indexed for MEDLINE]

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