Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis
IntroductionChemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk o...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1191943/full |
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| author | Elsa Curtit Martine Marie Bellanger Virginie Nerich Delphine Hequet Jean-Sebastien Frenel Olivier Cristeau Roman Rouzier |
| author_facet | Elsa Curtit Martine Marie Bellanger Virginie Nerich Delphine Hequet Jean-Sebastien Frenel Olivier Cristeau Roman Rouzier |
| author_sort | Elsa Curtit |
| collection | DOAJ |
| description | IntroductionChemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk of BC recurrence and predict the benefit of chemotherapy. The aim of this study was to estimate, from the French National Health Insurance (NHI) perspective, the cost-effectiveness of the Oncotype DX® test compared to standard of care (SoC; involving clinicopathological risk assessment only) among women with early, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC considered at high clinicopathological risk of recurrence.MethodsClinical outcomes and costs were estimated over a lifetime horizon based on a two-component model that comprised a short-term decision tree representing the adjuvant treatment choice guided by the therapeutic decision support strategy (Oncotype DX® test or SoC) and a Markov model to capture long-term outcomes.ResultsIn the base case, the Oncotype DX® test reduced CT use by 55.2% and resulted in 0.337 incremental quality-adjusted life-years gained and cost savings of €3,412 per patient, compared with SoC. Being more effective and less costly than SoC, Oncotype DX® testing was the dominant strategy.DiscussionWidespread implementation of Oncotype DX® testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system. |
| first_indexed | 2024-03-13T03:36:47Z |
| format | Article |
| id | doaj.art-c87ffa5b5cd743ce8a6acba397bb5d2c |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-13T03:36:47Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c87ffa5b5cd743ce8a6acba397bb5d2c2023-06-23T16:20:04ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-06-011310.3389/fonc.2023.11919431191943Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysisElsa Curtit0Martine Marie Bellanger1Virginie Nerich2Delphine Hequet3Jean-Sebastien Frenel4Olivier Cristeau5Roman Rouzier6University of Franche-Comté, University Hospital of Besançon J. Minjoz, INSERM, EFS UMR 1098, Besançon, FranceUMR CNRS6051, Ecole des Hautes Etudes en Santé Publique - School of Public Health (EHESP), University of Rennes, Rennes, FranceDepartment of Pharmacy, University Hospital of Besançon, France; INSERM, EFS-BFC, UMR 1098, University of Franche-Comté, Besançon, FranceInstitut Bourdonnais, Clinique Saint Jean de Dieu, Paris, FranceInstitut de Cancérologie de l’Ouest, Saint Herblain, FranceCreativ-Ceutical, Paris, FranceCentre François Baclesse, Caen, FranceIntroductionChemotherapy (CT) is commonly used as an adjuvant treatment for women with early breast cancer (BC). However, not all patients benefit from CT, while all are exposed to its short- and long-term toxicity. The Oncotype DX® test assesses cancer-related gene expression to estimate the risk of BC recurrence and predict the benefit of chemotherapy. The aim of this study was to estimate, from the French National Health Insurance (NHI) perspective, the cost-effectiveness of the Oncotype DX® test compared to standard of care (SoC; involving clinicopathological risk assessment only) among women with early, hormone receptor-positive, human epidermal growth factor receptor 2-negative BC considered at high clinicopathological risk of recurrence.MethodsClinical outcomes and costs were estimated over a lifetime horizon based on a two-component model that comprised a short-term decision tree representing the adjuvant treatment choice guided by the therapeutic decision support strategy (Oncotype DX® test or SoC) and a Markov model to capture long-term outcomes.ResultsIn the base case, the Oncotype DX® test reduced CT use by 55.2% and resulted in 0.337 incremental quality-adjusted life-years gained and cost savings of €3,412 per patient, compared with SoC. Being more effective and less costly than SoC, Oncotype DX® testing was the dominant strategy.DiscussionWidespread implementation of Oncotype DX® testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system.https://www.frontiersin.org/articles/10.3389/fonc.2023.1191943/fullgenomic signaturesadjuvant chemotherapycost-effectiveness analysisearly breast cancerdecision impact |
| spellingShingle | Elsa Curtit Martine Marie Bellanger Virginie Nerich Delphine Hequet Jean-Sebastien Frenel Olivier Cristeau Roman Rouzier Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis Frontiers in Oncology genomic signatures adjuvant chemotherapy cost-effectiveness analysis early breast cancer decision impact |
| title | Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis |
| title_full | Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis |
| title_fullStr | Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis |
| title_full_unstemmed | Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis |
| title_short | Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis |
| title_sort | genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in france a cost effectiveness analysis |
| topic | genomic signatures adjuvant chemotherapy cost-effectiveness analysis early breast cancer decision impact |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1191943/full |
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