Institut Curie, 26 rue d'Ulm, 75005 Paris, Saint Cloud, France.
Breast Cancer Res Treat. 2013 Jun;139(3):621-37. doi: 10.1007/s10549-013-2559-1. Epub 2013 May 31.
Breast cancer is the most common female cancer and is associated with a significant clinical and economic burden. Multigene assays and molecular markers represent an opportunity to direct chemotherapy only to patients likely to have significant benefit. This systematic review examines published health economic analyses to assess the support for adjuvant therapy decision making. Literature searches of PubMed, the Cochrane Library, and congress databases were carried out to identify economic evaluations of multigene assays and molecular markers published between 2002 and 2012. After screening and data extraction, study quality was assessed using the Quality of Health Economic Studies instrument. The review identified 29 publications that reported evaluations of two assays: Oncotype DX(®) and MammaPrint. Studies of both tests provided evidence that their routine use was cost saving or cost-effective versus conventional approaches. Benefits were driven by optimal allocation of adjuvant chemotherapy and reduction in chemotherapy utilization. Findings were sensitive to variation in the frequency of chemotherapy prescription, chemotherapy costs, and patients' risk profiles. Evidence suggests that multigene assays are likely cost saving or cost-effective relative to current approaches to adjuvant therapy. They should benefit decision making in early-stage breast cancer in a variety of settings worldwide.
乳腺癌是最常见的女性癌症，与重大的临床和经济负担相关。多基因检测和分子标志物为仅对可能有显著获益的患者提供化疗提供了机会。本系统综述考察了已发表的卫生经济学分析，以评估对辅助治疗决策的支持。通过对 PubMed、Cochrane 图书馆和会议数据库进行文献检索，确定了 2002 年至 2012 年发表的多基因检测和分子标志物的经济评价。在筛选和数据提取后，使用卫生经济研究质量工具评估了研究质量。本综述确定了 29 篇报告两种检测方法（Oncotype DX®和 MammaPrint）评价的文献。两项检测的研究都提供了证据，表明与常规方法相比，其常规使用可节省成本或具有成本效益。获益归因于辅助化疗的优化分配和化疗使用率的降低。研究结果对化疗处方频率、化疗成本和患者风险特征的变化敏感。证据表明，与目前的辅助治疗方法相比，多基因检测可能具有成本效益。它们应该有助于在全球各种环境下的早期乳腺癌的决策制定。
