Health economic impact of breast cancer index (BCI) in patients with hormone responsive breast cancer (HRBC) considering extended adjuvant endocrine therapy (EET).

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 25-25
Author(s):  
Tara Beth Sanft ◽  
Alyssa Berkowitz ◽  
Brock Schroeder ◽  
Christos Hatzis ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Adjuvant Endocrine Therapy ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
The Cost

25 Background: Previous research has demonstrated the benefit of EET for HRBC, however, the absolute benefit is modest and commits women to an extra 5 yrs of treatment. The Breast Cancer Index (BCI) is a gene expression-based test that has been validated to quantify the risk of late recurrence (BCI subscore) and to predict likelihood of benefit from EET (H/I subscore). We have previously shown that the use of BCI increases patient and physician confidence in decision-making and leads to fewer recommendations for EET. The current analysis extends our results to a larger sample size and presents a health economic analysis to assess the cost effectiveness of the use of BCI for EET decision-making. Methods: We developed a fact-based economic model to project the cost effectiveness of BCI using a cohort of 140 patients with stage I-III HRBC from Yale Cancer Center and University of Pittsburgh Medical Center who had completed ≥3.5 yrs of endocrine therapy and had undergone BCI testing in the context of this study. Physicians completed questionnaires to indicate their recommendations for EET before and after BCI results. Costs associated with EET, toxicity, follow-up, and metastatic recurrence were modeled over 5 yrs of extended therapy. Model inputs were based on published literature. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Changes in EET recommendations after BCI were observed in 29% of patients, with 21% changing from recommended to not recommended, and 8% from not recommended to recommended. The projected net cost savings of BCI testing in this population of patients who are disease free at 5 yrs post-diagnosis is $5,190 per patient tested. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving EET based on BCI results and decreased adverse events and comorbidities for patients with low BCI scores who did not receive EET. Conclusions: Based on the decision impact of BCI in a real-world cohort, the test is projected to be cost saving for women with early stage hormone receptor positive breast cancer who are recurrence free at 5 yrs post-diagnosis on adjuvant endocrine therapy.

Health economic analysis of breast cancer index in patients with ER+, LN- breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11504-e11504
Author(s):  
Gary Gustavsen ◽  
Brock Schroeder ◽  
Patrick Kennedy ◽  
Kristin Ciriello Pothier ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
Extended Endocrine Therapy ◽  
The Cost

e11504 Background: Numerous studies have demonstrated the cost utility of gene expression-based assessment of recurrence risk in breast cancer. Cost savings rely primarily on decreased use of adjuvant chemotherapy in patients predicted to be low-risk. Breast Cancer Index (BCI) is a gene expression-based test that significantly predicts overall risk of recurrence, late (≥5y) recurrence and likelihood of benefit from extended (≥5y) endocrine therapy in patients with ER+, LN- breast cancer. This study evaluated the potential cost utility of BCI from a US third-party payer perspective. Methods: A fact-based economic model was developed which projected the cost and effectiveness of BCI in a hypothetical population of patients with ER+, LN- breast cancer compared to standard clinicopathologic diagnostic modalities. Patients flowed through the model based on patterns of care and BCI data. Costs associated with adjuvant chemotherapy, toxicity, follow-up, endocrine therapy, and recurrence were modeled over 10 yrs. Model inputs were based primarily on published literature, and supplemented by interviews with disease experts and payers. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Use of BCI is projected to be cost saving in this patient population, with a net cost savings of $4,005 per patient tested after accounting for BCI cost. Gross cost savings were projected to be achieved through targeted use of adjuvant chemotherapy ($5,785), reduced recurrence in patients receiving extended endocrine therapy based on BCI ($2,350), and reduced recurrence in previously non-compliant patients ($370). Sensitivity analyses demonstrated that results were most sensitive to chemotherapy utilization in low- and intermediate-risk patients, cost of adjuvant chemotherapy, cost of recurrence, and percentage of patients classified as low risk. Conclusions: BCI is projected to be cost saving in an ER+, LN-, breast cancer patient population. Cost savings are achieved through projected impact on adjuvant chemotherapy use, extended endocrine therapy use, and endocrine therapy compliance. These findings require validation in additional cohorts, including studies of real-world clinical practice.

scholarly journals Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Mori ◽  
Carolyn J. Crandall ◽  
Tomoko Fujii ◽  
David A. Ganz
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Cost Saving ◽  
Fragility Fracture ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Term Care ◽  
Lifetime Horizon ◽  
The Cost

Abstract Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. Methods Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

Mapping the Decision-Making Process for Adjuvant Endocrine Therapy for Breast Cancer

2016 ◽  
Vol 37 (1) ◽  
pp. 79-90 ◽  
Author(s):  
Louise L. Beryl ◽  
Katharine A. S. Rendle ◽  
Meghan C. Halley ◽  
Katherine A. Gillespie ◽  
Suepattra G. May ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Endocrine Therapy ◽  
Health Care Organization ◽  
Cancer Recurrence ◽  
Decisional Conflict ◽  
Adjuvant Endocrine Therapy ◽  
Decision Making Process ◽  
Care Organization ◽  
Patient Decision Making

Background. Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor–positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. Objective. We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. Methods. A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs—decisional phase, decisional direction, and decisional resolve—which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. Results. Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. Conclusions. Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence.

scholarly journals Economic Evaluation of Letrozole for Early Breast Cancer in a Health Resource-Limited Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ming Ye ◽  
Jingsong Lu ◽  
Fan Yang ◽  
Bin Wu
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Cost Effective ◽  
Resource Limited Setting ◽  
Adjuvant Endocrine Therapy ◽  
Sensitivity Analyses ◽  
Health Resource ◽  
Resource Limited ◽  
Limited Setting

Objective. Long-term aromatase inhibitor (AI) therapy is expected to improve the health outcomes with high health resource consumption in early breast cancer. The aim of the study was to assess the cost-effectiveness of letrozole for postmenopausal women with estrogen receptor positive early breast cancer in a health resource-limited setting. Methods. A Markov model was developed to project the lifetime outcomes based on the clinical course of early breast cancer. The clinical and utility data were derived from reported results. Costs were estimated from the perspective of Chinese health care. The quality-adjusted life-year (QALY) and incremental cost-effective ratio (ICER) were measured. Probabilistic sensitivity and one-way analyses were conducted. Results. Compared to 5 years of tamoxifen therapy, 5 years of AI treatment with letrozole improved the QALYs (10.44 versus 10.84) and increased the lifetime costs (CNY ¥13,613 versus CNY ¥28,797), resulting in an ICER of CNY ¥38,092 /QALY. The ICER of 5 years of letrozole versus 2–3 years of tamoxifen and then letrozole was CNY ¥68,233 /QALY. Sensitivity analyses showed that the age of initiating adjuvant endocrine therapy was the most influential parameter. Conclusions. In health resource-limited settings, adjuvant endocrine therapy with letrozole is a cost-effective strategy compared to tamoxifen in women with early breast cancer.

scholarly journals Cost-effectiveness analysis of radiotherapy techniques for whole breast irradiation

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248220
Author(s):  
Yibo Xie ◽  
Beibei Guo ◽  
Rui Zhang
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Advanced Technology ◽  
Sensitivity Analyses ◽  
Tumor Control ◽  
Life Years ◽  
Whole Breast Radiotherapy ◽  
The Cost ◽  
The Impact

Background The current standard of care (SOC) for whole breast radiotherapy (WBRT) in the US is conventional tangential photon fields. Advanced WBRT techniques may provide similar tumor control and better normal tissue sparing, but it is controversial whether the medical benefits of an advanced technology are significant enough to justify its higher cost. Objective To analyze the cost-effectiveness of six advanced WBRT techniques compared with SOC. Methods We developed a Markov model to simulate health states for one cohort of women (65-year-old) with early-stage breast cancer over 15 years after WBRT. The cost effectiveness analyses of field-in-field (FIF), hybrid intensity modulated radiotherapy (IMRT), full IMRT, standard volumetric modulated arc therapy (STD-VMAT), multiple arc VMAT (MA-VMAT), non-coplanar VMAT (NC-VMAT) compared with SOC were performed with both tumor control and radiogenic side effects considered. Transition probabilities and utilities for each health state were obtained from literature. Costs incurred by payers were adopted from literature and Medicare data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were performed to evaluate the impact of uncertainties on the final results. Results FIF has the lowest ICER value of 1,511 $/QALY. The one-way analyses show that the cost-effectiveness of advanced WBRT techniques is most sensitive to the probability of developing contralateral breast cancer. PSAs show that SOC is more cost effective than almost all advanced WBRT techniques at a willingness-to-pay (WTP) threshold of 50,000 $/QALY, while FIF, hybrid IMRT and MA-VMAT are more cost-effective than SOC with a probability of 59.2%, 72.3% and 72.6% at a WTP threshold of 100,000 $/QALY, respectively. Conclusions FIF might be the most cost-effective option for WBRT patients at a WTP threshold of 50,000 $/QALY, while hybrid IMRT and MA-VMAT might be the most cost-effective options at a WTP threshold of 100,000 $/QALY.

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