Back to University of Twente portal
Constructive Technology Assessment (CTA) as a tool in Coverage with Evidence
Development: the case of the 70-gene prognosis signature for breast cancer diagnostics
Retèl, Valesca P. and Bueno-de-Mesquita, Jolien M. and Hummel, Marjan J.M. and Vijver van de, Marc J. and Douma, Kirsten F.L. and Karsenberg, Kim and Dam van, Frits S.A.M. and Krimpen van, Cees and Bellot, Frank E. and Roumen, Rudi M.H. and Linn, Sabine C. and Harten van, Wim H. (2009) Constructive Technology Assessment (CTA) as a tool in Coverage with Evidence
Development: the case of the 70-gene prognosis signature for breast cancer diagnostics. International Journal of Techology Assessment in Health Care, 25 (1). pp. 73-83. ISSN 0266-4623
![[img]](http://doc.utwente.nl/style/images/fileicons/application_pdf.png) | PDF Restricted to UT campus only: Request a copy 613Kb |
| Abstract: | Objectives: Constructive Technology Assessment (CTA) is a means to guide early implementation of new developments in society, and can be used as an evaluation tool for Coverage with Evidence Development (CED). We used CTA for the introduction of a new diagnostic test in the Netherlands, the 70-gene prognosis signature (MammaPrint®) for node-negative breast cancer patients. -
Methods: Studied aspects were (organizational) efficiency, patient-centeredness and diffusion scenarios. Pre-post structured surveys were conducted in fifteen community hospitals concerning changes in logistics and teamwork as a consequence of the introduction of the 70-gene signature. Patient-centeredness was measured by questionnaires and interviews regarding knowledge and psychological impact of the test. Diffusion scenarios, which are commonly applied in industry to anticipate on future development and diffusion of their products, have been applied in this study. - Results: Median implementation-time of the 70-gene signature was 1.2 months. Most changes were seen in pathology processes and adjuvant treatment decisions. Physicians valued the addition of the 70-gene signature information as beneficial for patient management. Patient-centeredness (n = 77, response 78 percent): patients receiving a concordant high-risk and discordant clinical low/high risk-signature showed significantly more negative emotions with respect to receiving both test-results compared with concordant low-risk and discordant clinical high/low risk-signature patients. The first scenario was written in 2004 before the introduction of the 70-gene signature and identified hypothetical developments that could influence diffusion; especially the “what-if” deviation describing a discussion on validity among physicians proved to be realistic. - Conclusions: Differences in speed of implementation and influenced treatment decisions were seen. Impact on patients seems especially related to discordance and its successive communication. In the future, scenario drafting will lead to input for model-based cost-effectiveness analysis. Finally, CTA can be useful as a tool to guide CED by adding monitoring and anticipation on possible developments during early implementation, to the assessment of promising new technologies. |
| Item Type: | Article |
| Copyright: | © 2009 Cambridge University Press |
| Faculty: | Management and Governance (SMG) |
| Research Group: | |
| Link to this item: | http://purl.utwente.nl/publications/71404 |
| Official URL: | http://dx.doi.org/10.1017/S0266462309090102 |
| Export this item as: | BibTeX EndNote HTML Citation Reference Manager |
Show download statistics for this publication
Show download statistics for this publicationRepository Staff Only: item control page
Metis ID: 256304