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Cost Effectiveness of Gene Expression Profile Testing in Community Practice
Journal of Clinical Oncology ( IF 45.3 ) Pub Date : 2018-02-20 , DOI: 10.1200/jco.2017.74.5034
Young Chandler 1 , Clyde B Schechter 1 , Jinani Jayasekera 1 , Aimee Near 1 , Suzanne C O'Neill 1 , Claudine Isaacs 1 , Charles E Phelps 1 , G Thomas Ray 1 , Tracy A Lieu 1 , Scott Ramsey 1 , Jeanne S Mandelblatt 1
Affiliation  

Purpose Gene expression profile (GEP) testing can support chemotherapy decision making for patients with early-stage, estrogen receptor-positive, human epidermal growth factor 2-negative breast cancers. This study evaluated the cost effectiveness of one GEP test, Onco type DX (Genomic Health, Redwood City, CA), in community practice with test-eligible patients age 40 to 79 years. Methods A simulation model compared 25-year societal incremental costs and quality-adjusted life-years (QALYs) of community Onco type DX use from 2005 to 2012 versus usual care in the pretesting era (2000 to 2004). Inputs included Onco type DX and chemotherapy data from an integrated health care system and national and published data on Onco type DX accuracy, chemotherapy effectiveness, utilities, survival and recurrence, and Medicare and patient costs. Sensitivity analyses varied individual parameters; results were also estimated for ideal conditions (ie, 100% testing and adherence to test-suggested treatment, perfect test accuracy, considering test effects on reassurance or worry, and lowest costs). Results Twenty-four percent of test-eligible patients had Onco type DX testing. Testing was higher in younger patients and patients with stage I disease ( v stage IIA), and 75.3% and 10.2% of patients with high and low recurrence risk scores received chemotherapy, respectively. The cost-effectiveness ratio for testing ( v usual care) was $188,125 per QALY. Considering test effects on worry versus reassurance decreased the cost-effectiveness ratio to $58,431 per QALY. With perfect test accuracy, the cost-effectiveness ratio was $28,947 per QALY, and under ideal conditions, it was $39,496 per QALY. Conclusion GEP testing is likely to have a high cost-effectiveness ratio on the basis of community practice patterns. However, realistic variations in assumptions about key variables could result in GEP testing having cost-effectiveness ratios in the range of other accepted interventions. The differences in cost-effectiveness ratios on the basis of community versus ideal conditions underscore the importance of considering real-world implementation when assessing the new technology.

中文翻译:

社区实践中基因表达谱测试的成本效益

目的 基因表达谱 (GEP) 测试可以支持早期、雌激素受体阳性、人表皮生长因子 2 阴性乳腺癌患者的化疗决策。本研究评估了一种 GEP 测试 Onco DX 型(Genomic Health,雷德伍德城,加利福尼亚州)在社区实践中对年龄 40 至 79 岁的符合测试资格的患者的成本效益。方法 模拟模型比较了 2005 年至 2012 年社区 Onco DX 型使用与预测试时代(2000 年至 2004 年)常规护理的 25 年社会增量成本和质量调整生命年 (QALY)。输入包括来自综合医疗保健系统的 Onco DX 型和化疗数据以及有关 Onco DX 型准确性、化疗有效性、效用、生存和复发以及医疗保险和患者成本的国家和已发布数据。敏感性分析不同的个体参数;还估计了理想条件下的结果(即 100% 测试并遵守测试建议的治疗、完美的测试准确性、考虑测试对安心或担忧的影响以及最低成本)。结果 24% 的符合测试资格的患者进行了 Onco DX 型测试。年轻患者和 I 期疾病 (v IIA 期) 患者的检测结果较高,高复发风险评分和低复发风险评分的患者分别有 75.3% 和 10.2% 接受了化疗。测试(与常规护理相比)的成本效益比为每个 QALY 188,125 美元。考虑到测试对担忧与安心的影响,成本效益比降至每 QALY 58,431 美元。在完美的测试精度下,每个 QALY 的成本效益比为 28,947 美元,在理想条件下,每个 QALY 的成本效益比为 39,496 美元。结论 基于社区实践模式,GEP 测试可能具有较高的成本效益比。然而,关键变量假设的实际变化可能会导致 GEP 测试在其他可接受的干预措施范围内具有成本效益比。基于社区与理想条件的成本效益比的差异强调了在评估新技术时考虑现实世界实施的重要性。
更新日期:2018-02-20
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