Cost-utility analysis of genomic profiling in early breast cancer in Colombia

Autores organización

• Luis Leonardo Rojas Beltran

  Autor

• 

  Andres Felipe Cardona Mendoza

  Autor

Autores

• Rojas-Reyes MX
• Rosselli D
• Ariza JG
• Ruiz-Patiño A

Grupos de investigación

• Grupo de Inmunología celular y molecular Universidad El Bosque (InmuBo)

  Investigador

  Maria Consuelo Romero Sanchez

Resumen

Background: In Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy. Methods: This study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed. Results: ODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and $554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was $416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy. Conclusions: Genomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 -EBC is a cost-effective strategy that allows Colombian NHS to maintain budget. © 2023, The Author(s).

© 2023. The Author(s).

Keywords

• cyclophosphamide; doxorubicin; paclitaxel; adjuvant chemotherapy; adjuvant therapy; adult; Article; breast cancer; cancer patient; cancer recurrence; Colombia; controlled study; cost control; cost effectiveness analysis; cost utility analysis; data base; deterministic sensitivity analysis; drug cost; early cancer; economic parameters; female; gross national product; health care cost; Hispanic; hormone receptor positive breast cancer; human; human epidermal growth factor receptor 2 negative breast cancer; lymph node negative early breast cancer; major clinical study; multiple cycle treatment; national health organization; net monetary benefit; outcome assessment; patient care; personalized medicine; population research; probabilistic sensitivity analysis; quality adjusted life year; sensitivity analysis; United States