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

• Published in: European journal of cancer (1990) 2010-05, Vol.46 (8), p.1382-1391
• Main Authors: Retèl, Valesca P, Joore, Manuela A, Knauer, Michael, Linn, Sabine C, Hauptmann, Michael, Harten, Wim H. van
• Format: Article
• Language: English
• Subjects: 70-Gene MammaPrint® signature; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - genetics; Breast Neoplasms - mortality; Chemotherapy, Adjuvant - economics; Cost-Benefit Analysis; Cost-effectiveness; Disease Progression; Female; Gene expression profiling; Hematology, Oncology and Palliative Medicine; Humans; Markov Chains; Medical sciences; Neoplasm Staging - economics; Neoplasm Staging - methods; Pharmacology. Drug treatments; Practice Guidelines as Topic; Prognosis; Sensitivity and Specificity; Tumors
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2010.02.035

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.