Mislick Kimberly, Schonfeld Warren, Bodnar Carolyn, Tong Kuo Bianchini
Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, USA.
Quorum Consulting, Inc, San Francisco, CA, USA.
Clinicoecon Outcomes Res. 2014 Jan 16;6:37-47. doi: 10.2147/CEOR.S53142. eCollection 2014.
To compare the cost-effectiveness of the tumor subtyping assays Mammostrat® and Oncotype DX® for assessing risk of recurrence in early-stage breast cancer and the potential benefit of adjuvant chemotherapy.
Cost-effectiveness analysis from a US third-party payer perspective. A 10 year Markov model was developed to estimate costs and effects of using each method of risk assessment. The percentages of patients assessed as high, moderate, or low risk were obtained from multicenter, prospective, randomized controlled trials. The analysis simulated the experience of women progressing through various model states representing clinical treatments and subsequent disease. Published recurrence data for Mammostrat® were adjusted appropriately to account for differences between definitions and samples of Oncotype DX® and Mammostrat® in the original clinical trials. Cost and utility data were obtained from previously published studies. Sensitivity analyses examined how base-case results might differ when input values and assumptions varied.
Base-case costs for women assessed using Mammostrat® were $15,782, compared with $18,051 for women assessed with Oncotype DX®. Thus, cost savings of $2,268 resulted from using Mammostrat®. Both Mammostrat® and Oncotype DX® resulted in similar life years (9.880 and 9.882) and quality-adjusted life years (7.935 and 7.940), respectively. Sensitivity analyses demonstrated that the assumptions made about recurrence are the key drivers of model results.
Cost savings associated with the use of Mammostrat® instead of Oncotype DX® are largely due to the difference in cost between the two tests. Since survival and quality-adjusted life years were similar using either assay, Mammostrat® has economic advantages for women with early-stage breast cancer.
比较肿瘤亚型检测方法Mammostrat®和Oncotype DX®在评估早期乳腺癌复发风险及辅助化疗潜在获益方面的成本效益。
从美国第三方支付方的角度进行成本效益分析。构建一个10年的马尔可夫模型，以估计使用每种风险评估方法的成本和效果。高、中、低风险患者的比例来自多中心、前瞻性、随机对照试验。该分析模拟了女性在代表临床治疗及后续疾病的各种模型状态下的进展情况。对Mammostrat®已发表的复发数据进行了适当调整，以考虑原始临床试验中Oncotype DX®和Mammostrat®在定义和样本方面的差异。成本和效用数据来自先前发表的研究。敏感性分析考察了输入值和假设变化时基准案例结果可能如何不同。
使用Mammostrat®评估的女性基准案例成本为15,782美元，而使用Oncotype DX®评估的女性为18,051美元。因此，使用Mammostrat®节省了2,268美元成本。Mammostrat®和Oncotype DX®分别产生了相似的生命年数（9.880和9.882）以及质量调整生命年数（7.935和7.940）。敏感性分析表明，关于复发的假设是模型结果的关键驱动因素。
与使用Oncotype DX®相比，使用Mammostrat®节省成本主要归因于两种检测方法在成本上的差异。由于两种检测方法的生存率和质量调整生命年数相似，Mammostrat®对早期乳腺癌女性具有经济优势。
