Limits...
Economic Impact of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in France.

Katz G, Romano O, Foa C, Vataire AL, Chantelard JV, Hervé R, Barletta H, Durieux A, Martin JP, Salmon R - PLoS ONE (2015)

Bottom Line: Sensitivity analyses were performed.The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per patient from a national insurance perspective and EUR 10,305 from a societal perspective.However, the delay in coverage has the potential to erode the quality of the French healthcare system, thus depriving patients of technologies that could improve clinical outcomes and allow healthcare professionals to better allocate hospital resources to improve the standard of care for all patients.

View Article: PubMed Central - PubMed

Affiliation: ESSEC Business School, Chair of Therapeutic Innovation, Paris, France and Singapore; Fondation Générale de Santé, Paris, France.

ABSTRACT

Background and aims: The heterogeneous nature of breast cancer can make decisions on adjuvant chemotherapy following surgical resection challenging. Oncotype DX is a validated gene expression profiling test that predicts the likelihood of adjuvant chemotherapy benefit in early-stage breast cancer. The aim of this study is to determine the costs of chemotherapy in private hospitals in France, and evaluate the cost-effectiveness of Oncotype DX from national insurance and societal perspectives.

Methods: A multicenter study was conducted in seven French private hospitals, capturing retrospective data from 106 patient files. Cost estimates were used in conjunction with a published Markov model to assess the cost-effectiveness of using Oncotype DX to inform chemotherapy decision making versus standard care. Sensitivity analyses were performed.

Results: The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per patient from a national insurance perspective and EUR 10,305 from a societal perspective. Cost-effectiveness analysis indicated that introducing Oncotype DX improved life expectancy (+0.18 years) and quality-adjusted life expectancy (+0.17 QALYs) versus standard care. Oncotype DX was found cost-effective from a national insurance perspective (EUR 2,134 per QALY gained) and cost saving from a societal perspective versus standard care. Inclusion of lost productivity costs in the modeling analysis meant that costs for eligible patients undergoing Oncotype DX testing were on average EUR 602 lower than costs for those receiving standard care.

Conclusions: As Oncotype DX was found both cost and life-saving from a societal perspective, the test was considered to be dominant to standard care. However, the delay in coverage has the potential to erode the quality of the French healthcare system, thus depriving patients of technologies that could improve clinical outcomes and allow healthcare professionals to better allocate hospital resources to improve the standard of care for all patients.

No MeSH data available.


Related in: MedlinePlus

Cost-effectiveness scatterplot of the probabilistic sensitivity analysis.The cost-effectiveness scatterplot shows incremental costs (€) versus incremental effectiveness expressed in quality-adjusted life years (QALYs) for the comparison of Oncotype DX with standard care. Each blue point represents one iteration of the probabilistic sensitivity analysis (with data based on sampling from distributions around clinical and cost parameters). The red point indicates the mean (of 1,000 iterations).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4472722&req=5

pone.0128880.g001: Cost-effectiveness scatterplot of the probabilistic sensitivity analysis.The cost-effectiveness scatterplot shows incremental costs (€) versus incremental effectiveness expressed in quality-adjusted life years (QALYs) for the comparison of Oncotype DX with standard care. Each blue point represents one iteration of the probabilistic sensitivity analysis (with data based on sampling from distributions around clinical and cost parameters). The red point indicates the mean (of 1,000 iterations).

Mentions: Probabilistic sensitivity analysis with sampling from distributions around key model input with 1,000 iterations (Fig 1) showed that there was 30% probability that Oncotype DX would be dominant to standard care (cost and life saving). Assuming a willingness to pay of EUR 30,000 per QALY gained, all 1,000 iterations indicated that Oncotype DX would be cost-effective relative to standard care in the French private hospital setting.


Economic Impact of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in France.

Katz G, Romano O, Foa C, Vataire AL, Chantelard JV, Hervé R, Barletta H, Durieux A, Martin JP, Salmon R - PLoS ONE (2015)

Cost-effectiveness scatterplot of the probabilistic sensitivity analysis.The cost-effectiveness scatterplot shows incremental costs (€) versus incremental effectiveness expressed in quality-adjusted life years (QALYs) for the comparison of Oncotype DX with standard care. Each blue point represents one iteration of the probabilistic sensitivity analysis (with data based on sampling from distributions around clinical and cost parameters). The red point indicates the mean (of 1,000 iterations).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472722&req=5

pone.0128880.g001: Cost-effectiveness scatterplot of the probabilistic sensitivity analysis.The cost-effectiveness scatterplot shows incremental costs (€) versus incremental effectiveness expressed in quality-adjusted life years (QALYs) for the comparison of Oncotype DX with standard care. Each blue point represents one iteration of the probabilistic sensitivity analysis (with data based on sampling from distributions around clinical and cost parameters). The red point indicates the mean (of 1,000 iterations).
Mentions: Probabilistic sensitivity analysis with sampling from distributions around key model input with 1,000 iterations (Fig 1) showed that there was 30% probability that Oncotype DX would be dominant to standard care (cost and life saving). Assuming a willingness to pay of EUR 30,000 per QALY gained, all 1,000 iterations indicated that Oncotype DX would be cost-effective relative to standard care in the French private hospital setting.

Bottom Line: Sensitivity analyses were performed.The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per patient from a national insurance perspective and EUR 10,305 from a societal perspective.However, the delay in coverage has the potential to erode the quality of the French healthcare system, thus depriving patients of technologies that could improve clinical outcomes and allow healthcare professionals to better allocate hospital resources to improve the standard of care for all patients.

View Article: PubMed Central - PubMed

Affiliation: ESSEC Business School, Chair of Therapeutic Innovation, Paris, France and Singapore; Fondation Générale de Santé, Paris, France.

ABSTRACT

Background and aims: The heterogeneous nature of breast cancer can make decisions on adjuvant chemotherapy following surgical resection challenging. Oncotype DX is a validated gene expression profiling test that predicts the likelihood of adjuvant chemotherapy benefit in early-stage breast cancer. The aim of this study is to determine the costs of chemotherapy in private hospitals in France, and evaluate the cost-effectiveness of Oncotype DX from national insurance and societal perspectives.

Methods: A multicenter study was conducted in seven French private hospitals, capturing retrospective data from 106 patient files. Cost estimates were used in conjunction with a published Markov model to assess the cost-effectiveness of using Oncotype DX to inform chemotherapy decision making versus standard care. Sensitivity analyses were performed.

Results: The cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per patient from a national insurance perspective and EUR 10,305 from a societal perspective. Cost-effectiveness analysis indicated that introducing Oncotype DX improved life expectancy (+0.18 years) and quality-adjusted life expectancy (+0.17 QALYs) versus standard care. Oncotype DX was found cost-effective from a national insurance perspective (EUR 2,134 per QALY gained) and cost saving from a societal perspective versus standard care. Inclusion of lost productivity costs in the modeling analysis meant that costs for eligible patients undergoing Oncotype DX testing were on average EUR 602 lower than costs for those receiving standard care.

Conclusions: As Oncotype DX was found both cost and life-saving from a societal perspective, the test was considered to be dominant to standard care. However, the delay in coverage has the potential to erode the quality of the French healthcare system, thus depriving patients of technologies that could improve clinical outcomes and allow healthcare professionals to better allocate hospital resources to improve the standard of care for all patients.

No MeSH data available.


Related in: MedlinePlus