Constructive technology assessment of gene expression profiling for breast cancer


Retèl, Valesca Pavlawna (2011) Constructive technology assessment of gene expression profiling for breast cancer. thesis.

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Abstract:Constructive Technology Assessment (CTA) can be used as a complementary
approach to Health Technology Assessment (HTA), especially for the early and
dynamic introduction of new technologies in a controlled way. CTA is based on the
idea that during the course of technology development, choices are constantly
being made about the form, the function, and the use of that technology. In this
dissertation the mixed method approach of CTA covers an integral assessment of
clinical, economic, patient-related, ethical/juridical, and organizational domains.
Diffusion scenarios, which are commonly applied in industry to anticipate on their
strategies concerning future development, have been adapted to monitor the
dynamics in this study.
The aim of this dissertation was to contribute to the knowledge on early stage HTA
by performing a CTA for the introduction and diffusion of gene expression profiling
for breast cancer patients. As a clinical case, the introduction and diffusion of the
70-gene prognosis signature (MammaPrintTM) using microarray analysis was
evaluated. The research objectives were twofold: first to develop the CTA method
in early stages of technology development and second, to apply the CTA method
to the case of the 70-gene signature for breast cancer, in order to support and
anticipate on the introduction of this new diagnostic test, specified in different CTA
This study showed that the CTA methodology can be a useful tool to guide
controlled early implementation of a promising technology and its possible use for
coverage decisions, in this case the 70-gene signature for breast cancer patients.
The patient information regarding the 70-gene signature appeared to be clear and
satisfactory and resulted in a good understanding of (the consequences of) the
genomic profile. In general, the 70-gene signature seems most cost-effective in
terms of quality adjusted life years; the slightly more sensitive tests deliver more life
years, but leads to a substantial larger amount of adjuvant chemotherapy and
hence higher costs, thus demanding a higher willingness to pay. Developing the
70-gene signature based on paraffin instead of fresh frozen tissue could establish
a higher cost-effectiveness and could thus be a worthwhile investment. Finally,
when incorporating scenarios in the decision model, it became apparent that early
anticipation on certain aspects is necessary to reach the potential costeffectiveness.
Item Type:Thesis
Faculty of Behavioural, Management and Social sciences (BMS)
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