System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish 4 citations

PubMed: 37427133 DOI: 10.3389/fonc.2023.1191943

Genomic signature to guide adjuvant chemotherapy treatment decisions for early breast cancer patients in France: a cost-effectiveness analysis.

Front Oncol 13:1191943

Authors: Elsa Curtit, Martine Marie Bellanger, Virginie Nerich, Delphine Hequet, Jean-Sebastien Frenel, Olivier Cristeau, Roman Rouzier

Affiliations

  • University of Franche-Comté, University Hospital of Besançon J. Minjoz, INSERM, EFS UMR 1098, Besançon, France.
  • UMR CNRS6051, Ecole des Hautes Etudes en Santé Publique - School of Public Health (EHESP), University of Rennes, Rennes, France.
  • Department of Pharmacy, University Hospital of Besançon, France; INSERM, EFS-BFC, UMR 1098, University of Franche-Comté, Besançon, France.
  • Institut Bourdonnais, Clinique Saint Jean de Dieu, Paris, France.
  • Institut de Cancérologie de l'Ouest, Saint Herblain, France.
  • Creativ-Ceutical, Paris, France.
  • Centre François Baclesse, Caen, France.

Abstract

Introduction

Chemotherapy (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.

Methods

Clinical 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.

Results

In 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.

Discussion

Widespread implementation of Oncotype DX testing would improve patient care, provide equitable access to more personalized medicine, and bring cost savings to the health system.

MeSH

Research Design, Breast Neoplasms, Cost Savings, Neoplasms, Drug Therapy, Chemotherapy, Adjuvant, Breast, Therapeutics, Chemotherapy

Cited by