Cost Effectiveness of Molecular Profiling for Adjuvant Decision Making in Patients With Node-Negative Breast Cancer
Cost Effectiveness of Molecular Profiling for Adjuvant Decision Making in Patients With Node-Negative Breast Cancer
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DOI：
10.1200/jco.2013.54.9931
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发表时间：
2014-11-01
影响因子：
45.3
通讯作者：
Saghatchian, Mahasti
中科院分区：
文献类型：
--
作者：
Bonastre, Julia;Marguet, Sophie;Saghatchian, Mahasti
目的对用于指导淋巴结阴性乳腺癌 (NNBC) 患者和雌激素受体 (ER) 阳性患者亚组辅助化疗决策的 70 基因特征进行经济评估。患者和方法我们使用混合方法，结合来自 70 基因特征（未治疗患者）多中心验证研究的患者级数据和化疗疗效、单位成本和效用值的二级来源。比较了决定辅助化疗的三种策略：70 基因特征、Adjuvantl Online 和所有患者的化疗。在基本案例分析中，计算了这三种策略在 10 年期间的法国国民保险计划成本、生命年 (LY) 和质量调整生命年 (QALY)。结合自助法和概率敏感性分析，使用净货币收益计算成本效益可接受性曲线。结果三种策略之间的 LY 和 QALY 平均差异相似。 70 基因特征策略与较高的成本相关，与 Adjuvantl Online 相比，平均差异为 (sic)2,037（范围，(sic)1,472 至 (sic)2,515）；与系统化疗相比，平均差异为 (sic)657 (95% CI，-(sic)642 至 (sic)3,130)。对于每个 QALY 50,000 人的支付意愿阈值（原文如此），佐剂成为最具成本效益策略的概率为 92%（ER 阳性患者为 76%）！在线策略中，系统化疗策略占 6%（ER 阳性患者为 4%），70 基因策略占 2%（ER 阳性患者为 20%）。 结论 基于 70 基因特征优化辅助化疗决策对于 NNBC 患者不太可能具有成本效益。 (C) 2014 年美国临床肿瘤学会
PurposeTo conduct an economic evaluation of the 70-gene signature used to guide adjuvant chemotherapy decision making both in patients with node-negative breast cancer (NNBC) and in the subgroup of estrogen receptor (ER) -positive patients.Patients and MethodsWe used a mixed approach combining patient-level data from a multicenter validation study of the 70-gene signature (untreated patients) and secondary sources for chemotherapy efficacy, unit costs, and utility values. Three strategies on which to base the decision to administer adjuvant chemotherapy were compared: the 70-gene signature, Adjuvantl Online, and chemotherapy in all patients. In the base-case analysis, costs from the French National Insurance Scheme, life-years (LYs), and quality-adjusted life-years (QALYs) were computed for the three strategies over a 10-year period. Cost-effectiveness acceptability curves using the net monetary benefit were computed, combining bootstrap and probabilistic sensitivity analyses.ResultsThe mean differences in LYs and QALYs were similar between the three strategies. The 70-gene signature strategy was associated with a higher cost, with a mean difference of (sic)2,037 (range, (sic)1,472 to (sic)2,515) compared with Adjuvantl Online and of (sic)657 (95% CI, -(sic)642 to (sic)3,130) compared with systematic chemotherapy. For a (sic)50,000 per QALY willingness-to-pay threshold, the probability of being the most cost-effective strategy was 92% (76% in ER-positive patients) for the Adjuvant! Online strategy, 6% (4% in ER-positive patients) for the systematic chemotherapy strategy, and 2% (20% in ER-positive patients) for the 70-gene strategy.ConclusionOptimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost effective in patients with NNBC. (C) 2014 by American Society of Clinical Oncology