Cost-Effectiveness Analysis of the Oncotype DX Breast Recurrence Score
breast cancer
chemotherapy
cost-effectiveness
the Oncotype DX test
tumour profiling test
Journal
ClinicoEconomics and outcomes research : CEOR
ISSN: 1178-6981
Titre abrégé: Clinicoecon Outcomes Res
Pays: New Zealand
ID NLM: 101560564
Informations de publication
Date de publication:
2024
2024
Historique:
received:
17
01
2024
accepted:
14
05
2024
medline:
10
6
2024
pubmed:
10
6
2024
entrez:
10
6
2024
Statut:
epublish
Résumé
The 21-gene assay (the Oncotype DX Breast Recurrence Score A cost-effectiveness model consisted of a decision-tree to stratify patients according to their Recurrence Score (RS) results and the use of adjuvant chemotherapy, followed by a Markov component to estimate the long-term costs and outcomes of the chosen treatment. Distributions of patients and distant recurrence probabilities were derived from the TAILORx (N0) and RxPONDER (N1) trials. The model was evaluated from a healthcare payer and societal perspective. Endocrine therapy and chemotherapy use were informed using clinical expert opinion to reflect US clinical practice and were combined with Medicare drug costs (2021) to estimate the cost of treatment. Societal costs included lost productivity and patient out-of-pocket costs obtained from literature. The Oncotype DX test generated more quality-adjusted life-years (QALYs) (N0: 0.25; N1: 0.08) at a lower cost (N0: -$13,395; N1: -$2526) compared to clinical-pathological risk alone from a societal cost perspective. The overall conclusions from the model did not change when considering a payer perspective. The main cost drivers were avoidance of distant recurrence for N0 (-$12,578), and the cost of adjuvant chemotherapy for N1 (-$2133). Lost productivity had a major impact in the societal perspective analysis (N0: -$4607; N1: -$1586). Adjuvant chemotherapy decisions based on the RS result led to more life year gains and lower healthcare costs (dominant) compared to using clinical-pathological risk factors alone among patients with HR+/HER2- N0 and N1 early-stage breast cancer.
Sections du résumé
Background and Objectives
UNASSIGNED
The 21-gene assay (the Oncotype DX Breast Recurrence Score
Materials and Methods
UNASSIGNED
A cost-effectiveness model consisted of a decision-tree to stratify patients according to their Recurrence Score (RS) results and the use of adjuvant chemotherapy, followed by a Markov component to estimate the long-term costs and outcomes of the chosen treatment. Distributions of patients and distant recurrence probabilities were derived from the TAILORx (N0) and RxPONDER (N1) trials. The model was evaluated from a healthcare payer and societal perspective. Endocrine therapy and chemotherapy use were informed using clinical expert opinion to reflect US clinical practice and were combined with Medicare drug costs (2021) to estimate the cost of treatment. Societal costs included lost productivity and patient out-of-pocket costs obtained from literature.
Results
UNASSIGNED
The Oncotype DX test generated more quality-adjusted life-years (QALYs) (N0: 0.25; N1: 0.08) at a lower cost (N0: -$13,395; N1: -$2526) compared to clinical-pathological risk alone from a societal cost perspective. The overall conclusions from the model did not change when considering a payer perspective. The main cost drivers were avoidance of distant recurrence for N0 (-$12,578), and the cost of adjuvant chemotherapy for N1 (-$2133). Lost productivity had a major impact in the societal perspective analysis (N0: -$4607; N1: -$1586).
Conclusion
UNASSIGNED
Adjuvant chemotherapy decisions based on the RS result led to more life year gains and lower healthcare costs (dominant) compared to using clinical-pathological risk factors alone among patients with HR+/HER2- N0 and N1 early-stage breast cancer.
Identifiants
pubmed: 38855430
doi: 10.2147/CEOR.S449711
pii: 449711
pmc: PMC11162226
doi:
Types de publication
Journal Article
Langues
eng
Pagination
471-482Informations de copyright
© 2024 Berdunov et al.
Déclaration de conflit d'intérêts
Vladislav Berdunov and Ewan Laws: employee of Putnam, who have received funding from Exact Sciences. Gebra Cuyun Carter, Christy Russell, Sara Campbell: employee and stockholder of Exact Sciences. Roger Luo has no conflicts of interest to declare. Yara Abdou and Jeremy Force: served as paid consultant for Exact Sciences.