Gene expression profiling and breast cancer care: What are the potential benefits and policy implications?

Oestreicher, Nina; Ramsey, Scott D.; Linden, Hannah M.; McCune, Jeannine S.; Veer, Laura J. van’t; Burke, Wylie; Veenstra, David L.

doi:10.1097/01.gim.0000170776.31248.75

Cited by 61 publications

(40 citation statements)

References 53 publications

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“…These results were recently confirmed on a larger set of patients [33]. The study by Oestreicher et al led to similar conclusions and suggested that performing gene expression profiling to identify the high-risk breast cancer patients who are likely to benefit most from adjuvant chemotherapy may yield net cost savings of $2,882 per patient [34]. All these studies were based on retrospective data, and their authors pointed out that the evidence about the economic outcomes was not very solid, since cost-effectiveness is difficult to assess until the clinical relevance of genomic testing for treatment decision-making purposes is confirmed.…”

Section: Discussionsupporting

confidence: 68%

Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients

Marino

Siani

Bertucci

et al. 2010

Breast Cancer Res Treat

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with heterogeneous benefits as well as with morbidity and financial costs. This study aimed to assess the economic impact of using gene-expression profiling to guide decision-making about chemotherapy, and to discuss the coverage/reimbursement issues involved. Methods:Retrospective data on 246 patients included in a randomized trial (PACS01) were analyzed. Tumours were genotyped using DNA microarrays (189-gene signature), and patients were classified depending on whether or not they were likely to benefit from chemotherapy regimens without taxanes. Standard anthracyclines plus taxane chemotherapy (strategy AT) was compared with the innovative strategy based on genomic testing (GEN).Statistical analyses involved bootstrap methods and sensitivity analyses. Results:The AT and GEN strategies yielded similar 5-year metastasis-free survival rates. In comparison with AT, GEN was cost-effective when genomic testing costs were less than 2,090€. With genomic testing costs higher than 2,919 euros, AT was cost-effective.Considering a 30% decrease in the price of docetaxel (the patent rights being about to expire), GEN was cost-effective if the cost of genomic testing was in the 0€-1,139€ range; whereas AT was cost-effective if genomic testing costs were higher than1,891 euros. Conclusions:The use of gene-expression profiling to guide decision-making about chemotherapy for N+ breast cancer patients is potentially cost-effective. Since genomic testing and the drugs targeted in these tests yield greater well-being than the sum of those resulting from separate use, questions arise about how to deal with extra-well being in decision-making about coverage/reimbursement.

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Section: Discussionsupporting

confidence: 68%

Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients

Marino

Siani

Bertucci

et al. 2010

Breast Cancer Res Treat

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“…116 Of the six studies assessing Oncotype DX, 74,111,115 two estimated that the test would dominate standard care strategies, with Oncotype DX found to produce a gain in QALYs and a reduction in costs. 112,113 Both of these studies were funded by the manufacturer.…”

Section: Cost-effectiveness Analyses Of Multiparameter Testingmentioning

confidence: 99%

“…74,113,115,116 Two studies 112,113 assessed populations that included only patients with lymph node-positive disease, both of which evaluated Oncotype DX. Four studies reported specific details of patients' level of lymph node involvement; 112,113,115,116 most restricted their populations to patients with low levels (1-3) of lymph node involvement, with only one study 111 including patients with higher (1-9) lymph node involvement.…”

Section: Cost-effectiveness Analyses Of Multiparameter Testingmentioning

confidence: 99%

“…This includes cost-benefit analyses, cost-utility analysis and cost-effectiveness analyses. A total of seven studies, 74,[111][112][113][114][115][116] published between 2005 and 2013, were identified in the review: four directly from Ovid, and three via additional hand-searching. No head-to-head comparisons of the alternative genomic tests were identified.…”

Section: Participating Centresmentioning

confidence: 99%

“…Six studies assessed the impact of Oncotype DX (one in each of Canada, 111 the USA, 112 the UK, 74 Germany, 113 Australia 114 and Japan 115 ), and one assessed the impact of MammaPrint in the Netherlands. 116 No head-to-head comparisons of the alternative genomic tests have been conducted. Four studies 74,112,113 either were funded by the test manufacturer or were carried out by researchers who worked for the manufacturer.…”

Section: Cost-effectiveness Analyses Of Multiparameter Testingmentioning

confidence: 99%

See 2 more Smart Citations

OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer

Stein

Dunn²,

Bartlett

et al. 2016

Health Technol Assess

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 10/34/01. The contractual start date was in May 2012. The draft report began editorial review in May 2014 and was accepted for publication in September 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Background: There i...

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The cost of adjuvant chemotherapy in patients with early‐stage breast carcinoma

Oestreicher

Ramsey

Linden

et al. 2005

Cancer

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BACKGROUNDIn the U.S., the majority of premenopausal patients with early‐stage breast carcinoma are treated with adjuvant chemotherapy. However, to the authors' knowledge, there have been few formal analyses of adjuvant chemotherapy cost performed to date, especially in premenopausal women. The objective of the current study was to evaluate the direct medical cost of adjuvant chemotherapy in women with early‐stage breast carcinoma.METHODSThe attributable cost of adjuvant chemotherapy was evaluated by comparing the total cost of care for patients with breast carcinoma (cases) during the period from diagnosis to 9 months subsequent with the cost for age‐matched and gender‐matched control patients without breast carcinoma over an equivalent time period. The authors identified cases from a linked database of claims records from a managed care organization, and the Cancer Surveillance System registry. Controls were identified from the managed care organization from which the cases originated. Resource prices were based on reimbursements from the managed care organization.RESULTSThe attributable cost of adjuvant chemotherapy was estimated to be $23,019 (95% confidence interval, $19,596–$26,441), based on 1239 women. The cost appeared to decrease with increasing age at diagnosis, with total costs of $26,834, $19,889, and $17,098 for women < 50, 50–59, and ≥ 60 years, respectively. Also, costs were higher for regional versus local disease ($36,076 vs. $12,659), for women who had a mastectomy versus breast‐conserving surgery ($31,075 vs. $17,889), and for women who had no comorbidities versus ≥ 1 comorbidity ($23,606 vs. $21,340). Contributors to high chemotherapy cost included use of chemotherapy agents not included in clinical guidelines during the study period, use of supportive care agents, and hospitalizations.CONCLUSIONSThe attributable cost of adjuvant chemotherapy in patients with early‐stage breast carcinoma is significant. The integration of managed care claims data with clinical data from the Cancer Surveillance System registry offered a unique opportunity to derive more informative and accurate disease burden estimates in oncology. Cancer 2005. © 2005 American Cancer Society.

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Gene expression profiling and breast cancer care: What are the potential benefits and policy implications?

Cited by 61 publications

References 53 publications

Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients

Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients

OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer

The cost of adjuvant chemotherapy in patients with early‐stage breast carcinoma

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