Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model
Objective: To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). Method: The cost-utility study was carried out using a discrete event simulation model representing the natural hist...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-01-01
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| Series: | Gaceta Sanitaria |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0213911118302140 |
| _version_ | 1819116778267082752 |
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| author | Oliver Ibarrondo Isabel Álvarez-López Frederick Freundlich Arantzazu Arrospide Elena Galve-Calvo María Gutiérrez-Toribio Arrate Plazaola Javier Mar |
| author_facet | Oliver Ibarrondo Isabel Álvarez-López Frederick Freundlich Arantzazu Arrospide Elena Galve-Calvo María Gutiérrez-Toribio Arrate Plazaola Javier Mar |
| author_sort | Oliver Ibarrondo |
| collection | DOAJ |
| description | Objective: To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). Method: The cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. Results: From a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. Conclusions: Oncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings. Resumen: Objetivo: Llevar a cabo un análisis de coste-utilidad del uso del test genómico Oncotype en el País Vasco (España) para informar la decisión de uso de quimioterapia. Método: El estudio de coste-utilidad se realizó mediante un modelo de simulación de eventos discretos que representó la evolución natural del cáncer de mama. La decisión de tratamiento con quimioterapia basada en Oncotype se comparó con el estándar de tratamiento basado en criterios clínico-patológicos. El modelo incluyó datos clínicos de hospitales vascos y la literatura para calcular la ratio de coste-efectividad incremental (RCEI) mediante análisis determinista y probabilístico, el plano coste-efectividad, la curva de aceptabilidad y el valor esperado de la información perfecta. El estudio adoptó una perspectiva tanto sanitaria como social. Resultados: El análisis determinista estimó una RCEI para Oncotype de 17.453 euros/año de vida ajustado por calidad (AVAC) con descuento y 9613 euros euros/AVAC sin descuento, desde la perspectiva sanitaria. El 85% de las simulaciones estuvieron por debajo el umbral de aceptabilidad para España. La variabilidad paramétrica asociada a los resultados de Oncotype fue el mayor factor de incertidumbre de la decisión. Conclusiones: Oncotype constituye una intervención coste-efectiva, ya que cada AVAC ganado tiene asociado un coste inferior a 25.000 euros. El test es dominante desde una perspectiva social al lograr mayor salud acompañada de ahorros. Keywords: Oncotype Dx, Genomic test, Cost-effectiveness, Acceptability curve, Expected value of perfect information, Discrete event simulation, Palabras clave: Oncotype Dx, Test genómico, Coste-efectividad, Curva de aceptabilidad, Valor esperado de la información perfecta, Simulación de eventos discretos |
| first_indexed | 2024-12-22T05:22:29Z |
| format | Article |
| id | doaj.art-13ea16b2bab14802ae397ea669f4de79 |
| institution | Directory Open Access Journal |
| issn | 0213-9111 |
| language | English |
| last_indexed | 2024-12-22T05:22:29Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gaceta Sanitaria |
| spelling | doaj.art-13ea16b2bab14802ae397ea669f4de792022-12-21T18:37:41ZengElsevierGaceta Sanitaria0213-91112020-01-013416168Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation modelOliver Ibarrondo0Isabel Álvarez-López1Frederick Freundlich2Arantzazu Arrospide3Elena Galve-Calvo4María Gutiérrez-Toribio5Arrate Plazaola6Javier Mar7AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Corresponding author.Medical Oncology Service, Donostia University Hospital, Donostia-San Sebastian, SpainFaculty of Business, Mondragon University, Oñati, SpainAP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Biodonostia Health Research Institute, Donostia-San Sebastian, Spain; Network for Health Services Research on Chronic Patients (REDISSEC), Kronikgune Group, Bilbao, SpainMedical Oncology Service, Basurto University Hospital, Bilbao, SpainMedical Oncology Service, Araba University Hospital, Vitoria-Gasteiz, SpainMedical Oncology Service, Onkologikoa, Donostia-San Sebastian, SpainAP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Biodonostia Health Research Institute, Donostia-San Sebastian, Spain; Network for Health Services Research on Chronic Patients (REDISSEC), Kronikgune Group, Bilbao, SpainObjective: To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). Method: The cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. Results: From a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. Conclusions: Oncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings. Resumen: Objetivo: Llevar a cabo un análisis de coste-utilidad del uso del test genómico Oncotype en el País Vasco (España) para informar la decisión de uso de quimioterapia. Método: El estudio de coste-utilidad se realizó mediante un modelo de simulación de eventos discretos que representó la evolución natural del cáncer de mama. La decisión de tratamiento con quimioterapia basada en Oncotype se comparó con el estándar de tratamiento basado en criterios clínico-patológicos. El modelo incluyó datos clínicos de hospitales vascos y la literatura para calcular la ratio de coste-efectividad incremental (RCEI) mediante análisis determinista y probabilístico, el plano coste-efectividad, la curva de aceptabilidad y el valor esperado de la información perfecta. El estudio adoptó una perspectiva tanto sanitaria como social. Resultados: El análisis determinista estimó una RCEI para Oncotype de 17.453 euros/año de vida ajustado por calidad (AVAC) con descuento y 9613 euros euros/AVAC sin descuento, desde la perspectiva sanitaria. El 85% de las simulaciones estuvieron por debajo el umbral de aceptabilidad para España. La variabilidad paramétrica asociada a los resultados de Oncotype fue el mayor factor de incertidumbre de la decisión. Conclusiones: Oncotype constituye una intervención coste-efectiva, ya que cada AVAC ganado tiene asociado un coste inferior a 25.000 euros. El test es dominante desde una perspectiva social al lograr mayor salud acompañada de ahorros. Keywords: Oncotype Dx, Genomic test, Cost-effectiveness, Acceptability curve, Expected value of perfect information, Discrete event simulation, Palabras clave: Oncotype Dx, Test genómico, Coste-efectividad, Curva de aceptabilidad, Valor esperado de la información perfecta, Simulación de eventos discretoshttp://www.sciencedirect.com/science/article/pii/S0213911118302140 |
| spellingShingle | Oliver Ibarrondo Isabel Álvarez-López Frederick Freundlich Arantzazu Arrospide Elena Galve-Calvo María Gutiérrez-Toribio Arrate Plazaola Javier Mar Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model Gaceta Sanitaria |
| title | Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model |
| title_full | Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model |
| title_fullStr | Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model |
| title_full_unstemmed | Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model |
| title_short | Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model |
| title_sort | probabilistic cost utility analysis and expected value of perfect information for the oncotype multigenic test a discrete event simulation model |
| url | http://www.sciencedirect.com/science/article/pii/S0213911118302140 |
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