Examining the cost-effectiveness of baseline left ventricular function assessment among breast cancer patients undergoing anthracycline-based therapy

• Published in: Breast cancer research and treatment 2019-07, Vol.176 (2), p.261-270
• Main Authors: Abu-Khalaf, Maysa M., Safonov, Anton, Stratton, Jamie, Wang, Shiyi, Hatzis, Christos, Park, Esther, Pusztai, Lajos, Gross, Cary P., Russell, Raymond
• Format: Article
• Language: English
• Subjects: Angiography; Anthracycline; Anthracyclines; Breast cancer; Cancer; Cancer patients; Cancer research; Cardiology; Cardiotoxicity; Cardiovascular disease; Coronary artery; Coronary heart disease; Cost analysis; Diagnosis; Economic aspects; Health risk assessment; Markov chains; Markov processes; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Monoclonal antibodies; Multivariate analysis; Oncology; Review; Risk factors; Targeted cancer therapy; Trastuzumab; Ventricle
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-019-05178-z

Background There is a lack of consensus to guide which breast cancer patients require left ventricular function assessment (LVEF) prior to anthracycline therapy; the cost-effectiveness of screening this patient population has not been previously evaluated. Methods We performed a retrospective analysis of the Yale Nuclear Cardiology Database, including 702 patients with baseline equilibrium radionuclide angiography (ERNA) scan prior to anthracycline and/or trastuzumab therapy. We sought to examine associations between abnormal baseline LVEF and potential cardiac risk factors. Additionally, we designed a Markov model to determine the incremental cost-effectiveness ratio (ICER) of ERNA screening for women aged 55 with stage I–III breast cancer from a payer perspective over a lifetime horizon. Results An abnormal LVEF was observed in 2% ( n  = 14) of patients. There were no significant associations on multivariate analysis performed on self-reported risk factors. Our analysis showed LVEF screening is cost-effective with ICER of $45,473 per QALY gained. For a willingness-to-pay threshold of $100,000/ QALY, LVEF screening had an 81.9% probability of being cost-effective. Under the same threshold, screening was cost-effective for non-anthracycline cardiotoxicity risk of RR ≤ 0.58, as compared to anthracycline regimens. Conclusions Age, preexisting cardiac risk factors and coronary artery disease did not predict a baseline abnormal LVEF. While the prevalence of an abnormal baseline LVEF is low in patients with breast cancer, our results suggest that cardiac screening prior to anthracycline is cost-effective.