Cost-Effectiveness of the 21-Gene Breast Cancer Assay in Mexico
Cost-Effectiveness of the 21-Gene Breast Cancer Assay in Mexico
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DOI：
10.1007/s12325-015-0190-8
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发表时间：
2015-03-01
影响因子：
3.8
通讯作者：
Valentine, William J.
中科院分区：
文献类型：
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作者：
Bargallo-Rocha, Juan Enrique;Lara-Medina, Fernando;Valentine, William J.
21 基因乳腺癌检测（Oncotype DXA (R)；Genomic Health, Inc.）是一种经过验证的诊断测试，可预测激素受体阳性、人表皮生长受体 2 阴性的早期乳腺癌患者辅助化疗获益的可能性以及 10 年远处复发的风险。本分析的目的是评估在墨西哥使用该检测为辅助化疗决策提供信息的成本效益。开发了马尔可夫模型，以对使用传统诊断程序或 21 基因检测为辅助化疗建议提供信息的情况下的远处复发、生存和直接成本进行长期预测。转变概率和风险调整取自已发表的里程碑式试验。成本 [2011 年墨西哥比索 (MXN)] 是从 Instituto Mexicano del Seguro Social 的角度估算的。成本和临床效益每年折扣 5%。在化验测试后，大约 66% 之前接受化疗的患者仅在考虑化验结果后才建议接受激素治疗。此外，大约 10% 之前仅接受激素治疗的患者的建议更改为添加化疗。与常规护理相比，这种优化的治疗分配使每位患者的平均预期寿命延长了 0.068 年，并使每位患者的直接成本增加了 1707 墨西哥比索 [2011 年美元 (USD) 129]。这相当于每增加生命年增加 25,244 墨西哥比索（1914 美元）的成本效益比 (ICER)。 在墨西哥的早期乳腺癌患者中，与当前护理标准相比，使用 21 基因检测指导辅助治疗决策预计将改善预期寿命，每增加生命年 ICER 为 25,244 墨西哥比索（1914 美元），这在范围通常被认为具有成本效益。
The 21-gene breast cancer assay (Oncotype DXA (R); Genomic Health, Inc.) is a validated diagnostic test that predicts the likelihood of adjuvant chemotherapy benefit and 10-year risk of distant recurrence in patients with hormone-receptor-positive, human epidermal growth receptor 2-negative, early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Mexico.A Markov model was developed to make long-term projections of distant recurrence, survival, and direct costs in scenarios using conventional diagnostic procedures or the 21-gene assay to inform adjuvant chemotherapy recommendations. Transition probabilities and risk adjustment were taken from published landmark trials. Costs [2011 Mexican Pesos (MXN)] were estimated from an Instituto Mexicano del Seguro Social perspective. Costs and clinical benefits were discounted at 5% annually.Following assay testing, approximately 66% of patients previously receiving chemotherapy were recommended to receive hormone therapy only after consideration of assay results. Furthermore, approximately 10% of those previously allocated hormone therapy alone had their recommendation changed to add chemotherapy. This optimized therapy allocation led to improved mean life expectancy by 0.068 years per patient and increased direct costs by MXN 1707 [2011 United States Dollars (USD) 129] per patient versus usual care. This is equated to an incremental cost-effectiveness ratio (ICER) of MXN 25,244 (USD 1914) per life-year gained.In early-stage breast cancer patients in Mexico, guiding decision making on adjuvant therapy using the 21-gene assay was projected to improve life expectancy in comparison with the current standard of care, with an ICER of MXN 25,244 (USD 1914) per life-year gained, which is within the range generally considered cost-effective.