Quorum Consulting, Inc, 180 Sansome St, 10th Floor, San Francisco, CA 94104, USA.
Am J Manag Care. 2010 Dec 1;16(12):e333-42.
To evaluate the cost-effectiveness of 70-gene MammaPrint signature (Agendia Inc, Huntington Beach, CA) vs Adjuvant! Online software (AS) (http://www.adjuvantonline.com) in patients 60 years or younger with early-stage breast cancer.
Cost-effectiveness and cost-utility analyses from a US payer perspective.
A Markov model with 3 health states was constructed. In the base case model, risk classification and patient outcomes were based on a 70-gene signature validation study. Efficacy of chemotherapy was derived from a published meta-analysis of clinical trials. An alternative model using data from AS and from the Surveillance, Epidemiology and End Results registry was built to examine the external validity of the base case model. The incremental benefits, costs, and cost-effectiveness of treatment guided by 70-gene signature were calculated.
In the base case model, 70-gene signature reclassified 29% of patients and spared 10% of patients from chemotherapy. Compared with the AS strategy, the 70-gene signature strategy was associated with $1440 higher total cost per patient and with 0.14 additional life-year or 0.15 additional quality-adjusted life-year. Overall, the incremental cost-effectiveness ratios were approximately $10,000 per life-year or quality-adjusted life-year in the base case model and $700 in the alternative model. The model results were sensitive to estrogen receptor status, the proportion of patients classified as high risk vs low risk, and the overall survival in each risk group.
A 70-gene signature is likely to be a cost-effective strategy to guide adjuvant chemotherapy treatment in younger patients with early-stage breast cancer.
评估 70 基因 MammaPrint 特征（加利福尼亚州亨廷顿海滩的 Agendia 公司）与 Adjuvant！在线软件（AS）（http://www.adjuvantonline.com）在 60 岁及以下早期乳腺癌患者中的成本效益。
从美国支付者的角度进行成本效益和成本效用分析。
构建了一个具有 3 种健康状态的马尔可夫模型。在基础模型中，风险分类和患者结局基于 70 基因特征验证研究。化疗的疗效来自对临床试验的已发表荟萃分析。构建了一个使用 AS 和监测、流行病学和最终结果登记处数据的替代模型，以检验基础模型的外部有效性。计算了基于 70 基因特征的治疗的增量收益、成本和成本效益。
在基础模型中，70 基因特征重新分类了 29%的患者，并使 10%的患者免于化疗。与 AS 策略相比，70 基因特征策略与每位患者 1440 美元的总成本增加和 0.14 个额外的寿命年或 0.15 个额外的质量调整寿命年相关。总体而言，基础模型中的增量成本效益比约为每寿命年或质量调整寿命年 10000 美元，替代模型中为 700 美元。模型结果对雌激素受体状态、高风险与低风险患者的比例以及每个风险组的总体生存率敏感。
70 基因特征可能是一种指导年轻早期乳腺癌患者辅助化疗治疗的具有成本效益的策略。
