Schegerin Marc, Tosteson Anna N A, Kaufman Peter A, Paulsen Keith D, Pogue Brian W
Amos Tuck School of Business, Dartmouth College, Hanover, NH 03755, USA.
Breast Cancer Res Treat. 2009 Apr;114(3):537-47. doi: 10.1007/s10549-008-0025-2. Epub 2008 Apr 25.
The use of neoadjuvant chemotherapy in cases of locally advanced breast cancer has been steadily increasing, and is also in wider use for other cancers. As a consequence, a growing number of studies have focused on the question of how best to assess the therapeutic response to various chemotherapy or systemic therapy regimens. Prognostic imaging of response to therapy early in the course of a planned chemotherapy regimen could be of considerable value, particularly if shifting to another therapy regimen would be more effective.
A cost effectiveness analysis was completed, specific to imaging of neoadjuvant chemotherapy response in breast cancer, to determine the dominant parameters that would make imaging systems cost effective. The cost analysis was completed with respect to a system for near infrared spectral imaging, but the costs are not dramatically different for other systems such as PET or MRI. Using a standard metric of $25,000 per discounted life year gained as a measure of a successful system.
It is shown that system specificity and patient average life expectancy are not dominant factors. Increases in cure rate and the efficacy of the initial chemotherapy are dominant factors. As long as the initial chemotherapy was less than 90% effective, most imaging systems would be cost effective, and if the cure rate of the disease could be increased as little as 1% through a change to alternate therapy, then the cost effectiveness of the system would be acceptable.
Based upon this simple economic analysis, diagnostic imaging of neoadjuvant chemotherapy appears warranted, assuming that it can be shown that the early shift from ineffective neoadjuvant chemotherapy to a more effective one has a measurable benefit in cure rate. This study indicates that the most important issue is to assess the added benefit of individualized chemotherapy in patient management, and clinical trials in this area would then provide the data required to justify analysis of prognostic imaging procedures.
新辅助化疗在局部晚期乳腺癌病例中的应用一直在稳步增加，在其他癌症中也有更广泛的应用。因此，越来越多的研究聚焦于如何最好地评估对各种化疗或全身治疗方案的治疗反应这一问题。在计划的化疗方案早期对治疗反应进行预后成像可能具有相当大的价值，特别是如果转向另一种治疗方案会更有效。
针对乳腺癌新辅助化疗反应的成像进行了一项成本效益分析，以确定使成像系统具有成本效益的主要参数。成本分析是针对近红外光谱成像系统完成的，但对于PET或MRI等其他系统，成本差异不大。使用每获得一个贴现生命年25,000美元的标准指标作为衡量成功系统的标准。
结果表明，系统特异性和患者平均预期寿命不是主要因素。治愈率和初始化疗疗效的提高是主要因素。只要初始化疗的有效率低于90%，大多数成像系统将具有成本效益，并且如果通过改用替代疗法可使疾病治愈率提高1%，那么该系统的成本效益将是可接受的。
基于这一简单的经济分析，假设能够证明从无效的新辅助化疗早期转向更有效的化疗在治愈率方面有可衡量的益处，那么新辅助化疗的诊断成像似乎是合理的。本研究表明，最重要的问题是评估个体化化疗在患者管理中的额外益处，而该领域的临床试验将提供证明预后成像程序分析合理性所需的数据。
