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Breast Cancer Res Treat. 2019 Jul;176(2):261-270. doi: 10.1007/s10549-019-05178-z. Epub 2019 Apr 24.

Examining the cost-effectiveness of baseline left ventricular function assessment among breast cancer patients undergoing anthracycline-based therapy.

Author information

1
Section of Solid Tumors, Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, 7th Floor, Philadelphia, PA, 19107, USA. maysa.abu-khalaf@jefferson.edu.
2
Hospital of University of Pennsylvania, Philadelphia, PA, USA.
3
Stamford Health, Stamford, CT, USA.
4
Yale University School of Public Health, New Haven, CT, USA.
5
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA.
6
Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA.
7
Diagnostic Radiology Department, UCLA, Los Angeles, CA, USA.
8
Cardiovascular Institute of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Abstract

BACKGROUND:

There is a lack of consensus to guide which breast cancer patients require left ventricular function assessment (LVEF) prior to anthracycline therapy; the cost-effectiveness of screening this patient population has not been previously evaluated.

METHODS:

We performed a retrospective analysis of the Yale Nuclear Cardiology Database, including 702 patients with baseline equilibrium radionuclide angiography (ERNA) scan prior to anthracycline and/or trastuzumab therapy. We sought to examine associations between abnormal baseline LVEF and potential cardiac risk factors. Additionally, we designed a Markov model to determine the incremental cost-effectiveness ratio (ICER) of ERNA screening for women aged 55 with stage I-III breast cancer from a payer perspective over a lifetime horizon.

RESULTS:

An abnormal LVEF was observed in 2% (n = 14) of patients. There were no significant associations on multivariate analysis performed on self-reported risk factors. Our analysis showed LVEF screening is cost-effective with ICER of $45,473 per QALY gained. For a willingness-to-pay threshold of $100,000/ QALY, LVEF screening had an 81.9% probability of being cost-effective. Under the same threshold, screening was cost-effective for non-anthracycline cardiotoxicity risk of RR ≤ 0.58, as compared to anthracycline regimens.

CONCLUSIONS:

Age, preexisting cardiac risk factors and coronary artery disease did not predict a baseline abnormal LVEF. While the prevalence of an abnormal baseline LVEF is low in patients with breast cancer, our results suggest that cardiac screening prior to anthracycline is cost-effective.

KEYWORDS:

Anthracycline; Breast cancer; Cost-effectiveness; Left ventricular function assessment; Screening

PMID:
31020471
DOI:
10.1007/s10549-019-05178-z

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