Özmen Vahit, Çakar Burcu, Gökmen Erhan, Özdoğan Mustafa, Güler Nilufer, Uras Cihan, Ok Engin, Demircan Orhan, Işıkdoğan Abdurrahman, Saip Pınar
Department of General Surgery, İstanbul University School of Medicine, İstanbul, Turkey.
Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey.
Eur J Breast Health. 2019 Jul 1;15(3):183-190. doi: 10.5152/ejbh.2019.4761. eCollection 2019 Jul.
Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective.
A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%.
The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice.
As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.
乳腺癌是一种异质性疾病，基因谱分析有助于辅助治疗的个体化。Oncotype DX是一种经过验证的检测方法，用于预测辅助全身治疗的获益。本研究的目的是确定土耳其政府医院化疗的成本，并从国家保险的角度评估Oncotype DX的成本效益。
开发了一个马尔可夫模型，用于对雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性、腋窝淋巴结阴性或腋窝淋巴结转移不超过3个的早期乳腺癌患者的远处复发、生存、质量调整预期寿命和直接成本进行长期预测。以土耳其决策影响研究的患者数据作为模型参考。在该研究中，土耳其的10个学术中心参与了一项前瞻性试验。在165例pT1-3、pN0-N¹mic、ER阳性且HER-2阴性肿瘤患者中，分别有57%的患者复发评分（RS）低、35%的患者RS中等、8%的患者RS高。Oncotype DX检测后化疗治疗决策的总体变化率为33%。
公立医院辅助化疗的成本估计为3649美元，Oncotype Dx检测的成本为5141美元。基于成本效益分析，与标准治疗相比，Oncotype DX检测估计可提高预期寿命（增加0.86年）和质量调整预期寿命（增加0.68个质量调整生命年）。与当前临床实践相比，Oncotype DX的增量成本效益比（ICER）估计为每获得1个质量调整生命年7207.9美元，每获得1个生命年5720.6美元。
从国家层面来看，Oncotype DX既具有成本效益又能挽救生命，因此应将该检测引入土耳其ER阳性、HER-2阴性早期乳腺癌患者的标准治疗中。
