The cost-effectiveness of EndoPredict to inform adjuvant chemotherapy decisions in early breast cancer

Hinde, Sebastian, Theriou, Chloi, May, Shirley, Matthews, Lucy, Arbon, Amy, Fallowfield, Lesley and Bloomfield, David (2019) The cost-effectiveness of EndoPredict to inform adjuvant chemotherapy decisions in early breast cancer. Health Policy and Technology, 8 (1). pp. 75-83. ISSN 2211-8837

[img] PDF - Accepted Version
Restricted to SRO admin only until 24 December 2019.
Available under License Creative Commons Attribution-NonCommercial No Derivatives.

Download (975kB)

Abstract

Background
Adjuvant chemotherapy in breast cancer patients post resection has been estimated to reduce mortality rates by up to 30%. However, the heterogeneous nature of the disease and patients implies that not all patients should receive the treatment. Many existing prognostic tools, may not definitively estimate the most effective treatment strategy, resulting in an indeterminate risk classification. In such cases gene expression profiling tests can aid the treatment decision.

Methods
This study evaluated the cost-effectiveness of EndoPredict in patients with indeterminate risk classification. A mathematical model was constructed to determine how the change in treatment decisions impacted the long term health of the population, and the future cost implications to the NHS.

Results
EndoPredict was found to lead to 36.9% of patients having a change in treatment decision. As a result its use was found to result in an increase in population health but also in total costs, resulting in an incremental cost-effectiveness ratio of £26,836 per quality adjusted life year. This was subject to significant parametric and structural uncertainty.

Conclusion
While EndoPredict was found to be more expensive overall, its ability to affect a more optimal allocation of chemotherapy, resulted in long term health gains, however, they were insufficient to justify the high cost of EndoPredict.

Item Type: Article
Keywords: breast cancer, genetic profiling, economics
Schools and Departments: Brighton and Sussex Medical School > Sussex Health Outcomes Research & Education in Cancer (SHORE-C)
Research Centres and Groups: Sussex Health Outcomes Research and Education in Cancer
Subjects: R Medicine > R Medicine (General) > R728 Practice of medicine. Medical practice economics
Depositing User: Lucy Matthews
Date Deposited: 21 Dec 2018 12:54
Last Modified: 01 Jul 2019 13:45
URI: http://sro.sussex.ac.uk/id/eprint/80948

View download statistics for this item

📧 Request an update