scholarly journals Cost Effectiveness of DCISionRT for Guiding Treatment of Ductal Carcinoma in Situ

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Ann C Raldow ◽  
David Sher ◽  
Aileen B Chen ◽  
Rinaa S Punglia
Keyword(s):  
Cost Effectiveness ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cost Effective ◽  
Base Case ◽  
Adjuvant Radiation ◽  
Case Scenario ◽  
The Cost

Abstract The DCISionRT test estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) as well as the benefit of adjuvant radiation therapy (RT). We determined the cost-effectiveness of DCISionRT using a Markov model simulating 10-year outcomes for 60-year-old women with DCIS based on nonrandomized data. Three strategies were compared: no testing, no RT (strategy 1); test all, RT for elevated risk only (strategy 2); and no testing, RT for all (strategy 3). We used utilities and costs from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women irradiated per IBE prevented. In the base-case scenario, strategy 1 was the cost-effective strategy. Strategy 2 was cost-effective compared with strategy 3 when the cost of DCISionRT was less than $4588. The number irradiated per IBE prevented were 8.37 and 15.46 for strategies 2 and 3, respectively, relative to strategy 1.

Cost Effectiveness of the Oncotype DX DCIS Score for Guiding Treatment of Patients With Ductal Carcinoma In Situ

2016 ◽  
Vol 34 (33) ◽  
pp. 3963-3968 ◽  
Author(s):  
Ann C. Raldow ◽  
David Sher ◽  
Aileen B. Chen ◽  
Abram Recht ◽  
Rinaa S. Punglia
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cost Effective ◽  
Risk Scores ◽  
High Grade ◽  
The Cost

Purpose The Oncotype DX DCIS Score short form (DCIS Score) estimates the risk of an ipsilateral breast event (IBE) in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery without adjuvant radiation therapy (RT). We determined the cost effectiveness of strategies using this test. Materials and Methods We developed a Markov model simulating 10-year outcomes for 60-year-old women eligible for the Eastern Cooperative Oncology Group E5194 study (cohort 1: low/intermediate-grade DCIS, ≤ 2.5 cm; cohort 2: high-grade DCIS, ≤ 1 cm) with each of five strategies: (1) no testing, no RT; (2) no testing, RT only for cohort 2; (3) no RT for low-grade DCIS, test for intermediate- and high-grade DCIS, RT for intermediate- or high-risk scores; (4) test all, RT for intermediate- or high-risk scores; and (5) no testing, RT for all. We used utilities and costs extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios and examined the number of women needed to irradiate per IBE prevented. Results No strategy using the DCIS Score was cost effective. The most cost-effective strategy (RT for none or RT for all) was sensitive to small differences between the utilities of receiving or not receiving RT and remaining without recurrence. The numbers needed to irradiate per IBE prevented were 10.5, 9.1, 7.5, and 13.1 for strategies 2 to 5, respectively, relative to strategy 1. Conclusion Strategies using the DCIS Score lowered the proportion of women undergoing RT per IBE prevented. However, no strategy incorporating the DCIS Score was cost effective. The cost effectiveness of RT was exquisitely utility sensitive, highlighting the importance of engaging patient preferences in this decision. Physicians should discuss trade-offs associated with omitting or adding adjuvant RT with each patient to maximize quality-of-life outcomes.

Cost-Effectiveness of Adjuvant Treatment for Ductal Carcinoma In Situ

2021 ◽  
pp. JCO.21.00831
Author(s):  
Apar Gupta ◽  
Sachin R. Jhawar ◽  
Mutlay Sayan ◽  
Zeinab A. Yehia ◽  
Bruce G. Haffty ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Standard Risk ◽  
Quality Adjusted Life ◽  
Good Risk

PURPOSE Ductal carcinoma in situ (DCIS) accounts for 20% of breast cancer cases in the United States and is potentially overtreated, leading to high expenditures and low-value care. We conducted a cost-effectiveness analysis evaluating all adjuvant treatment strategies for DCIS. METHODS A Markov model was created with six competing treatment strategies: observation, tamoxifen (TAM) alone, aromatase inhibitor (AI) alone, radiation treatment (RT) alone, RT + TAM, and RT + AI. Baseline recurrence rates were modeled using the NSABP B17 and RTOG 9804 trials for standard-risk and good-risk DCIS, respectively. Relative risk reductions and adverse event rates for each treatment strategy were derived from meta-analyses of large randomized trials. We used a willingness-to-pay threshold of $100,000 in US dollars/quality-adjusted life-year and a lifetime horizon for two cohorts of women, age 40 and 60 years. Comprehensive sensitivity analyses evaluated the robustness of base-case results. RESULTS RT alone was cost-effective for patients with standard-risk DCIS, and observation was cost-effective for patients with good-risk DCIS, across both age groups. Strategies including TAM or AI resulted in fewer quality-adjusted life-years than observation, because of the prolonged decrement in quality of life outweighing the modest benefit in ipsilateral risk reduction. In sensitivity analysis, RT alone was cost-effective for age 40, good-risk patients when ipsilateral risk reduction matched that of the RTOG 9804 trial, there was minimal increased risk of contralateral breast secondary malignancy, or there was strong patient willingness to pursue RT. CONCLUSION Our findings suggest that cost-effective and clinically optimal treatment strategies are RT alone for standard-risk DCIS and observation for good-risk DCIS, with personalization on the basis of patient age and preference for RT. Hormonal therapy is likely suboptimal for most patients with DCIS.

Adjuvant radiation therapy in small ductal carcinoma in situ

The Breast ◽  
2019 ◽  
Vol 43 ◽  
pp. 55-58
Author(s):  
Won Kyung Cho ◽  
Doo Ho Choi ◽  
Haeyoung Kim ◽  
Jae Myoung Noh ◽  
Won Park ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy

Cost-effectiveness of routine laparoscopic ultrasound for the assessment of resectability of gallbladder cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 272-272
Author(s):  
Thejus T. Jayakrishnan ◽  
Hasan Nadeem ◽  
Ryan Thomas Groeschl ◽  
Anthony J Zacharias ◽  
T. Clark Gamblin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Laparoscopy ◽  
Hepatic Metastases ◽  
Cost Effective ◽  
Laparoscopic Ultrasound ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost ◽  
Quality Adjusted Life

272 Background: In addition to a diagnostic laparoscopy (DL), aroutine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients. Methods: Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payers’ perspective), quality-adjusted-life-weeks (QALWs) and incremental-cost-effectiveness-ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/ QALY). Results: DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS, resulting in a cost reduction of $9,220 per quality adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased (threshold: $163.18) or the probability of exclusion from resection decreased (threshold 0.29) (Table represents the results of univariate analyses). Conclusions: Routine LUS with diagnostic laparoscopy for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in pre-operative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy. [Table: see text]

scholarly journals The hemodialysis prescription and cost effectiveness. Renal Physicians Association Working Committee on Clinical Guidelines.

1993 ◽  
Vol 4 (4) ◽  
pp. 1021-1027
Author(s):  
J C Hornberger
Keyword(s):  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Base Case ◽  
Uremic Toxin ◽  
Intradialytic Hypotension ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost

Case-mix adjusted mortality rates for patients undergoing hemodialysis for ESRD increased during the 1980s, despite the introduction of advanced dialysis technologies. Variations in dialysis practices suggest that excess mortality may be caused by inadequate uremic-toxin clearances. Cost-effectiveness analysis was used to assess whether attempts to improve uremic-toxin clearance are cost effective, assuming that these therapies are clinically effective. The medical literature was surveyed by the use of MEDLINE to assess the likelihood of clinical outcomes on the basis of the type of treatment given to the patient. Options considered in the model were delivered fractional urea clearance (Kt/V), dialysis-treatment duration, type of dialyzer membrane, dialysate, and ultrafiltration. Clinical outcomes included in the model were survival, severity of uremic symptoms, hospital days per year, and intradialytic hypotension and symptoms. Lifetime costs were calculated from data collected from a northern California dialysis center and abstracted from the literature. In the base-case scenario, it was assumed that increasing Kt/V to levels greater than 1 was effective in reducing morbidity and mortality. Under these assumptions, outpatient cost increased significantly, but the cost effectiveness of Kt/V equal to 1.5 was less than $50,000 per quality-adjusted life-year saved. These calculations indicate that, if higher levels of Kt/V prove clinically effective, they are also cost effective.

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