Validation of the GeneXpert Breast Cancer STRAT4 Assay for Rapid Analysis of Breast Cancer Biomarker Status From Fine-Needle Aspiration Biopsies in Tanzania (GX-BCB): Preliminary Results

Kimambo, Asteria; Ng, Dianna

doi:10.1093/ajcp/aqy104.330

Cited by 3 publications

(2 citation statements)

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“…For example, GeneXpert devices, which have already been deployed for diagnosis of tuberculosis and other infectious diseases, are being adapted to diagnose breast cancer. 47 Some global oncology programmes have begun experimenting with telepathology services. 48 49 As more researchers test novel approaches to deliver cancer care in sparsely populated rural areas, the solutions will benefit rural cancer patients everywhere.…”

Section: Discussionmentioning

confidence: 99%

Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency

Iyer

Flanigan²,

Wolf³

et al. 2020

BMJ Glob Health

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IntroductionDecisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We applied a novel geospatial framework to study these trade-offs in four African countries.MethodsGeolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson’s correlation, and spatial autocorrelation using the Global Moran’s I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation.ResultsPopulation density was inversely associated with travel time for all countries and levels of the health system (Pearson’s correlation range, health centres: −0.89 to −0.71; cancer referral centres: −0.92 to −0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (−0.310) and Tanzania (−0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (−0.579) and Malawi (−0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: −0.341; Tanzania: −0.259; Kenya: −0.595; Malawi: −0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries.ConclusionNegative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.

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Section: Discussionmentioning

confidence: 99%

Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency

Iyer

Flanigan²,

Wolf³

et al. 2020

BMJ Glob Health

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“… 10 , 27 Preliminary data also suggest that the STRAT4 assay has similarly favourable diagnostic performance with fine-needle aspirate samples, yielding the potential to expand availability of breast cancer molecular diagnostics to smaller district-level hospitals where traditional biopsies and tissue processors are not available. 28 …”

Section: Discussionmentioning

confidence: 99%

Breast cancer molecular diagnostics in Rwanda: a cost-minimization study of immunohistochemistry versus a novel GeneXpert® mRNA expression assay

Erfani

Gaga

Hakizimana

et al. 2023

Bull World Health Organ

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Objective To compare the financial and time cost of breast cancer biomarker analysis by immunohistochemistry with that by the Xpert ® STRAT4 assay. Methods We estimated costs (personnel, location, consumables and indirect) and time involved in breast cancer diagnosis at the Butaro Cancer Centre of Excellence, Rwanda, using time-driven activity-based costing. We performed a cost-minimization analysis to compare the cost of biomarker analysis for estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 status with immunohistochemistry versus STRAT4. We performed sensitivity analyses by altering laboratory-specific parameters for the two methods. Findings We estimated that breast cancer diagnosis in Rwanda costs 138.29 United States dollars (US$) per patient when conducting biomarker analysis by immunohistochemistry. At a realistic immunohistochemistry antibody utilization efficiency of 70%, biomarker analysis comprises 48.7% (US$ 67.33) of diagnostic costs and takes 33 min. We determined that biomarker analysis with STRAT4 yields a reduction in diagnosis cost of US$ 7.33 (10.9%; 7.33/67.33), and in pathologist and technician time of 20 min (60.6%; 20/33), per patient. Our sensitivity analysis revealed that no cost savings would be made in laboratories with antibody utilization efficiencies over 90%, or where only estrogen and/or progesterone receptor status are assessed; however, such operational efficiencies are unlikely, and more laboratories are pursuing human epidermal growth factor receptor-2 analysis as targeted therapies become increasingly available. Conclusion Breast cancer biomarker analysis with STRAT4 has the potential to reduce the required human and capital resources in sub-Saharan African laboratories, leading to improved treatment selection and better clinical outcomes.

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The Lancet Breast Cancer Commission

Coles,

Earl,

Anderson

et al. 2024

The Lancet

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Validation of the GeneXpert Breast Cancer STRAT4 Assay for Rapid Analysis of Breast Cancer Biomarker Status From Fine-Needle Aspiration Biopsies in Tanzania (GX-BCB): Preliminary Results

Cited by 3 publications

References 0 publications

Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency

Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency

Breast cancer molecular diagnostics in Rwanda: a cost-minimization study of immunohistochemistry versus a novel GeneXpert® mRNA expression assay

The Lancet Breast Cancer Commission

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