Abstract
For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer. A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis. The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice. Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.
Highlights
Breast cancer is the most common cancer and the 2nd leading cause of death from cancer among Canadian women[1]
The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice
The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice
Summary
Breast cancer (bca) is the most common cancer and the 2nd leading cause of death from cancer among Canadian women[1]. For women with lymph node (ln)–positive, estrogen receptor (er)–positive bca, current guidelines recommend treatment with both hormonal therapy and chemotherapy[2,3]. The 21-gene rs assay might be helpful in selecting patients with a lower risk of recurrence, for whom chemotherapy could be omitted. For women with lymph node (ln)–positive, estrogen receptor–positive, and her[2] (human epidermal growth factor receptor 2)–negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1–3 positive lns and a lower risk of recurrence. 70% of those in the highrisk rs category received 6 cycles of fec-d: 3 cycles of 5-fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2, followed by 3 cycles of docetaxel 100 mg/m2 (clinical expert opinion, 2018). All patients in that category who received chemotherapy were treated with 4 cycles of tc chemotherapy
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