Potential economic impact of the 21-gene expression assay on the treatment of breast cancer in brazil

Abstract

SummaryObjective. The 21-gene expression assay may support the decision regarding use of chemotherapy in early breast cancer. We sought to investigate the potential impact of incorporating the 21-gene expression assay into private practice in Brazil, from the perspective of third party payers. MethOds. We conducted a web-based survey with 30 (of a total of approximately 700) Brazilian medical oncologists, who were stratified by State according to the proportion of patients with breast cancer and private health insurance. We evaluated the possible treatment of first choice for patients with lymph-node-negative, estrogen-receptor-positive breast cancer, regardless of menopausal status. Interviewees were not aware of the objective of the study. Responses permitted a quantitative assessment of the care patterns regarding use of different chemotherapy regimens, type of premedication, use of growth factors, and use of intravenous antibiotics for febrile neutropenia. We calculated medication costs using the manufacturer's recommended prices. Other direct medical expenses, indirect medical costs, and non-medical costs were not included. Results. Considering a hypothetical cohort of 100 patients without access to the 21-gene expression assay, the survey showed that 84 patients would receive chemotherapy. Reclassifying patient eligibility for chemotherapy according to the 21-gene expression assay would lower this number to 49. For a hypothetical cohort of 100 patients with access to the test, US$ 79,361.43 would be saved in main direct medical costs. Such results, however, would greatly vary according to tumor size: the 21-gene expression assay could increase direct medical costs in T1 tumors, and decrease costs in cases with T >2 cm. cOnclusiOn. Considering the current price for the 21-gene expression assay in Brazil, our economic analysis suggests that such testing is an overall cost-saving, from the perspective of third party payers. Further, optimal use of resources would entail targeted use of the 21-gene expression assay.

A prospective clinical utility and pharmacoeconomic study of the impact of the 21-gene Recurrence Score® assay in oestrogen receptor positive node negative breast cancer

“…Furthermore, when the uncertainty around parameter estimates is allowed to vary in sensitivity analysis, the model reaches 95% cost-effectiveness below a threshold of $37,600. Our cost-effectiveness findings compare well to those found in other analyses in the literature across multiple health care systems including Israel, 21 Brazil, 22 the United States of America (USA), [23][24][25] the United Kingdom (UK) 26 and Japan. 27,28 It should be noted that because of structural differences between health care systems, direct comparisons of costeffectiveness results are difficult.…”

Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in breast cancer management: a systematic review and cost-effectiveness analysis

“…136 Nine articles were excluded after retrieving the full text because there were insufficient details to assess the validity of assumptions, 137 the economic evaluation was available only in abstract form, [138][139][140] the study used a different comparator 141 or for other reasons. [143][144][145] Klang et al 141 was excluded from the review as the exact nature of the comparator defined as clinical practice in Israel was unclear.…”

An overview of recently published medical papers in Brazilian scientific journals

“…Bagnoli et al14 verified the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast and conclude that aromatase through local estrogen synthesis in breast tissue plays an important role in breast carcinogenesis, mainly influencing MMP-2 and MMP-9 which are important participants in tumor cell invasion and dependence of their connection to CD44 for action. Bacchi et al15 looked at the 21-gene expression assay as a support to the decision regarding use of chemotherapy in early breast cancer. They conclude that considering the current price for the 21-gene expression assay in Brazil, our economic analysis suggests that such testing is an overall cost-saving, from the perspective of third party payers.…”