E-ISSN 2587-0831
Original Article
Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study
1 Department of General Surgery, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey  
2 Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey  
3 Division of Medical Oncology, Memorial Hospital, Antalya, Turkey  
4 Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Turkey  
5 Department of General Surgery, Acıbadem University, İstanbul, Turkey  
6 Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey  
7 Division of Medical Oncology, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakır, Turkey  
8 Division of Medical Oncology, Department of Internal Medicine, İstanbul University School of Medicine, İstanbul, Turkey  
Eur J Breast Health 2019; 15: 183-190
DOI: 10.5152/ejbh.2019.4761
Key Words: Early breast cancer, genetic profiling, oncotype-Dx, cost, markov model.
Abstract

 

Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment.  The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective.

 

Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial.  Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%.

 

Results: The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice.

 

Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey. 

 

 

Cite this article as: Özmen V, Çakar B, Gökmen E, Özdoğan M, Güler N, Uras C, Ok E, Demircan O, Işıkdoğan A, Saip P. Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study. Eur J Breast Health 2019; 15(3): 183-190.

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AVES | Copyright © 2019 Turkish Federation of Breast Diseases Associations | Latest Update: 01.10.2019