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
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Original Article
P: 183-190
July 2019

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
1. Department of General Surgery, İstanbul University 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
No information available.
No information available
Received Date: 14.02.2019
Accepted Date: 22.04.2019
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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 costeffectiveness 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.

Keywords:
Early breast cancer, genetic profiling, oncotype-Dx, cost, markov model