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PCN72 GENE EXPRESSION PROFILING FOR GUIDING ADJUVANT CHEMOTHERAPY DECISIONS IN WOMEN WITH EARLY BREAST CANCER: A COST-EFFECTIVENESS ANALYSIS OF 1000 STRATEGIES FOR THE PROVISION OF ADJUVANT! ONLINE, ONCOTYPE DX AND CHEMOTHERAPY

2011; Elsevier BV; Volume: 14; Issue: 3 Linguagem: Inglês

10.1016/j.jval.2011.02.927

1524-4733

Mike Paulden, Jacob Franek, Ba’ Pham, Murray Krahn,

Pharmaceutical Economics and Policy

Adjuvant chemotherapy decisions for women with early-stage breast cancer are complex. Oncotype DX, a gene expression profiling test, is validated at predicting distant recurrence-free response in patients with ER+ LN- early-stage breast cancer. This enables chemotherapy to be better targeted at higher risk patients than is possible through the use of Adjuvant! Online (AOL) or clinical judgement alone. However, existing cost-effectiveness analyses of Oncotype DX have numerous limitations: in particular, they consider a limited range of strategies and do not separately consider intermediate risk patients identified through either AOL or Oncotype DX. Our objective was to build an Ontario-based cost-effectiveness analysis which comprehensively addresses these limitations. We built upon a Markov model developed by Tsoi and colleagues, using data from the NSABP B-14 and B-20 clinical trials. We assumed that AOL and Oncotype DX may be provided separately or sequentially and considered the chemotherapy decision separately for every possible risk group, resulting in 1000 unique strategies for the provision of AOL, Oncotype DX and chemotherapy. Oncotype DX appears cost-effective for all patients, regardless of a patient's initial AOL risk assessment. The highest ICER is in patients at low AOL risk ($29,000 per QALY), while Oncotype DX dominates in patients at high AOL risk. Chemotherapy appears cost-effective only in patients at intermediate or high Oncotype DX risk. The highest ICER is in patients at low AOL and intermediate Oncotype DX risk ($64,000 per QALY). Chemotherapy is dominated in patients at low Oncotype DX risk. Oncotype DX appears to be cost-effective for all Ontario women with ER+ LN- early-stage breast cancer, regardless of the woman's initial AOL risk assessment. These results have informed the Ontario Health Technology Advisory Committee's recent deliberations regarding the funding of Oncotype DX in Ontario.