de Jongh Felix E, Efe Reva, Herrmann Kirsten H, Spoorendonk Jelle A
Breast Cancer Center South Holland South, Ikazia Ziekenhuis Rotterdam, Montessoriweg 1, 3083 AN, Rotterdam, Netherlands.
OPEN Health, Marten Meesweg 107, 3068 AV, Rotterdam, Netherlands.
Int J Breast Cancer. 2022 Sep 22;2022:5909724. doi: 10.1155/2022/5909724. eCollection 2022.
Patients with early-stage HR+/HER2- N0 breast cancer may receive adjuvant chemotherapy in combination with surgery. However, chemotherapy does not always lead to improved survival and incurs high healthcare costs and increased adverse events. To support decision-making regarding adjuvant chemotherapy, genomic profile testing performed with tests such as the Oncotype DX® test can help healthcare practitioners decide whether chemotherapy provides any benefit to these patients. As such, a cost-consequence model was developed with the aim to estimate the economic impact of using different gene expression tests or no testing, in patients with node-negative early-stage breast cancer.
A cost-consequence model was developed to estimate the economic impact of three different scenarios in the Dutch setting: (1) Oncotype DX® test, (2) MammaPrint®, and (3) and no genomic profile testing. The model included chemotherapy costs, administration costs, short- and long-term adverse event costs, productivity loss, genomic profiling testing costs, cost of cancer recurrence, and hospitalization costs.
A treatment paradigm with Oncotype DX resulted in average savings per patient of €6,768 vs. a paradigm with MammaPrint and €13,125 vs. a paradigm with no genomic testing. Furthermore, due to less patients receiving adjuvant chemotherapy through better targeting by the Oncotype DX test, fewer adverse events, sick days, practice visits, and hospitalizations were required compared to MammaPrint and no genomic profiling.
Testing with Oncotype DX test in Dutch clinical practice in patients with early-stage breast cancer proved to be cost-saving versus MammaPrint and no genomic profiling tests. Introducing the Oncotype DX test to the Dutch setting will likely reduce the economic resources that are required.
早期激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）且无淋巴结转移（N0）的乳腺癌患者可接受辅助化疗并结合手术治疗。然而，化疗并不总能提高生存率，还会带来高昂的医疗成本并增加不良事件。为支持关于辅助化疗的决策，使用如Oncotype DX®检测等进行基因组谱检测可帮助医疗从业者确定化疗是否对这些患者有益。因此，开发了一个成本-后果模型，旨在估计在淋巴结阴性的早期乳腺癌患者中使用不同基因表达检测或不进行检测的经济影响。
开发了一个成本-后果模型，以估计荷兰环境下三种不同情况的经济影响：（1）Oncotype DX®检测，（2）MammaPrint®检测，（3）不进行基因组谱检测。该模型包括化疗成本、给药成本、短期和长期不良事件成本、生产力损失、基因组谱检测成本、癌症复发成本和住院成本。
与使用MammaPrint检测的模式相比，使用Oncotype DX检测的治疗模式使每位患者平均节省6768欧元，与不进行基因组检测的模式相比平均节省13125欧元。此外，由于Oncotype DX检测能更精准地靶向，接受辅助化疗的患者更少，与MammaPrint检测和不进行基因组谱检测相比，不良事件、病假天数、门诊次数和住院次数都更少。
在荷兰的临床实践中，对早期乳腺癌患者使用Oncotype DX检测被证明与使用MammaPrint检测和不进行基因组谱检测相比具有成本节约优势。在荷兰引入Oncotype DX检测可能会减少所需的经济资源。
