Cost-effectiveness of the 70-gene signature versus St. Gallen guidelines and Adjuvant Online for early breast cancer

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Retèl, Valesca P. and Joore, Manuela A. and Knauer, Michael and Linn, Sabine C. and Hauptmann, Michael and Harten van, Wim H. (2010) Cost-effectiveness of the 70-gene signature versus St. Gallen guidelines and Adjuvant Online for early breast cancer. European Journal of Cancer, 46 (8). pp. 1382-1391. ISSN 0959-8049

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Abstract:Background: The 70-gene signature (MammaPrint®) is a prognostic test used to guide adjuvant treatment decisions in patients with node-negative breast cancer. In order to decide upon its use, a systematic comparative analysis of the effects of the 70-gene signature, the Sankt Gallen guidelines and the Adjuvant Online Software for these patients on survival, quality of life and costs is warranted. -
Methods: A Markov decision model was used to simulate the 20-year costs and outcomes (survival and quality-of-life adjusted survival (QALYs)) in a hypothetical cohort of node-negative, estrogen receptor positive breast cancer patients. Sensitivity and specificity of the three prognostic tools were based on 5 and 10 years breast cancer specific survival and distant metastasis as first event, derived from a pooled analysis consisting of 305 tumour samples from 3 previously reported validation studies concerning the 70-gene signature. -
Results: Small differences in survival, but substantial differences in quality-adjusted survival between the prognostic tools were observed. Quality-adjusted survival was highest when using the 70-gene signature. Based on costs per QALY, the 70-gene has the highest probability of being cost-effective for a willingness to pay for a QALY higher than €4600. Sankt Gallen showed the highest survival rates compared to the 70-gene signature, but leads to a substantial larger amount of adjuvant chemotherapy and hence higher costs, thus demanding a willingness to pay of €29.326 to save a life year. -
Conclusions: When deciding upon the cost-effectiveness of the prognostic tests, the 70-gene signature improves quality-adjusted survival and has the highest probability of being cost-effective.
Item Type:Article
Copyright:© 2010 Elsevier
Faculty:
Management and Governance (SMG)
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Link to this item:http://purl.utwente.nl/publications/71410
Official URL:http://dx.doi.org/10.1016/j.ejca.2010.02.035
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