CN3 – Early Stage Cost-Effectiveness Analysis of a Brca1-Like Test to Detect Triple Negative Breast Cancers Responsive to High Dose Alkylating Chemotherapy

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    Abstract

    Objectives: Triple negative breast cancers (TNBC) with a BRCA1-like profile may benefit from high dose alkylating chemotherapy (HDAC). This study examines whether treating TNBC with personalized HDAC based on BRCA1-like testing can be more cost-effective than current clinical practice. Additionally we estimated the minimum required prevalence of BRCA1-likeness and the required positive predictive value (PPV) for a BRCA1-like test to render this strategy cost-effective.

    Methods: Our markov model compared the outcomes of treating TNBC women with personalized HDAC based on BRCA1-like testing vs. current clinical practice from a societal Dutch perspective and a 20-year time horizon. From our base-case model we assessed: 1) the incremental number of respondents; 2) the incremental number of Quality Adjusted Life Years, 3) the incremental costs, and 4) the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis (SA) of all model parameters, and two-way SA of prevalence and PPV. Data were obtained from a current trial (NCT01057069), published literature and expert opinions where necessary.

    Results: Based on our base-case analysis with 68% BRCA1-like prevalence, 100% PPV, and costs of € 164 / test, treating TNBC according to BRCA1-like testing would be cost-effective (€16.192/QALY). One-way SA on the prevalence and PPV demonstrated that only the PPV drives the ICER changes. In two-way SA, the lower bound for the two parameters was: prevalence 39.6% and PPV 46.4%. Regardless of prevalence, at PPVs > 46.4% BRCA1-like testing was always cost-effective.

    Conclusions: Treating TNBC with personalized HDAC based on BRCA1-like testing is expected to be cost-effective at a minimum PPV of 46%. This information can help test developers in decisions on further research and development

    Original languageEnglish
    Pages (from-to)A323-A323
    JournalValue in health
    Volume17
    Issue number7
    DOIs
    Publication statusPublished - 2014
    EventISPOR 17th Annual European Congress 2014: New challenges for improving European health care - Amsterdam RAI, Amsterdam, Netherlands
    Duration: 8 Nov 201412 Nov 2014

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    Triple Negative Breast Neoplasms
    Cost-Benefit Analysis
    Costs and Cost Analysis
    Drug Therapy
    Quality-Adjusted Life Years
    Expert Testimony
    Statistical Models
    Research

    Keywords

    • METIS-309534
    • IR-94668

    Cite this

    @article{aac77df0645f4c3585770ef3372bc5f7,
    title = "CN3 – Early Stage Cost-Effectiveness Analysis of a Brca1-Like Test to Detect Triple Negative Breast Cancers Responsive to High Dose Alkylating Chemotherapy",
    abstract = "Objectives: Triple negative breast cancers (TNBC) with a BRCA1-like profile may benefit from high dose alkylating chemotherapy (HDAC). This study examines whether treating TNBC with personalized HDAC based on BRCA1-like testing can be more cost-effective than current clinical practice. Additionally we estimated the minimum required prevalence of BRCA1-likeness and the required positive predictive value (PPV) for a BRCA1-like test to render this strategy cost-effective.Methods: Our markov model compared the outcomes of treating TNBC women with personalized HDAC based on BRCA1-like testing vs. current clinical practice from a societal Dutch perspective and a 20-year time horizon. From our base-case model we assessed: 1) the incremental number of respondents; 2) the incremental number of Quality Adjusted Life Years, 3) the incremental costs, and 4) the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis (SA) of all model parameters, and two-way SA of prevalence and PPV. Data were obtained from a current trial (NCT01057069), published literature and expert opinions where necessary.Results: Based on our base-case analysis with 68{\%} BRCA1-like prevalence, 100{\%} PPV, and costs of € 164 / test, treating TNBC according to BRCA1-like testing would be cost-effective (€16.192/QALY). One-way SA on the prevalence and PPV demonstrated that only the PPV drives the ICER changes. In two-way SA, the lower bound for the two parameters was: prevalence 39.6{\%} and PPV 46.4{\%}. Regardless of prevalence, at PPVs > 46.4{\%} BRCA1-like testing was always cost-effective.Conclusions: Treating TNBC with personalized HDAC based on BRCA1-like testing is expected to be cost-effective at a minimum PPV of 46{\%}. This information can help test developers in decisions on further research and development",
    keywords = "METIS-309534, IR-94668",
    author = "{Miquel Cases}, A. and L.M.G. Steuten and V.P. Ret{\`e}l and {van Harten}, W.H.",
    year = "2014",
    doi = "10.1016/j.jval.2014.08.567",
    language = "English",
    volume = "17",
    pages = "A323--A323",
    journal = "Value in health",
    issn = "1098-3015",
    publisher = "Elsevier",
    number = "7",

    }

    CN3 – Early Stage Cost-Effectiveness Analysis of a Brca1-Like Test to Detect Triple Negative Breast Cancers Responsive to High Dose Alkylating Chemotherapy. / Miquel Cases, A.; Steuten, L.M.G.; Retèl, V.P.; van Harten, W.H.

    In: Value in health, Vol. 17, No. 7, 2014, p. A323-A323.

    Research output: Contribution to journalMeeting AbstractOther research output

    TY - JOUR

    T1 - CN3 – Early Stage Cost-Effectiveness Analysis of a Brca1-Like Test to Detect Triple Negative Breast Cancers Responsive to High Dose Alkylating Chemotherapy

    AU - Miquel Cases, A.

    AU - Steuten, L.M.G.

    AU - Retèl, V.P.

    AU - van Harten, W.H.

    PY - 2014

    Y1 - 2014

    N2 - Objectives: Triple negative breast cancers (TNBC) with a BRCA1-like profile may benefit from high dose alkylating chemotherapy (HDAC). This study examines whether treating TNBC with personalized HDAC based on BRCA1-like testing can be more cost-effective than current clinical practice. Additionally we estimated the minimum required prevalence of BRCA1-likeness and the required positive predictive value (PPV) for a BRCA1-like test to render this strategy cost-effective.Methods: Our markov model compared the outcomes of treating TNBC women with personalized HDAC based on BRCA1-like testing vs. current clinical practice from a societal Dutch perspective and a 20-year time horizon. From our base-case model we assessed: 1) the incremental number of respondents; 2) the incremental number of Quality Adjusted Life Years, 3) the incremental costs, and 4) the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis (SA) of all model parameters, and two-way SA of prevalence and PPV. Data were obtained from a current trial (NCT01057069), published literature and expert opinions where necessary.Results: Based on our base-case analysis with 68% BRCA1-like prevalence, 100% PPV, and costs of € 164 / test, treating TNBC according to BRCA1-like testing would be cost-effective (€16.192/QALY). One-way SA on the prevalence and PPV demonstrated that only the PPV drives the ICER changes. In two-way SA, the lower bound for the two parameters was: prevalence 39.6% and PPV 46.4%. Regardless of prevalence, at PPVs > 46.4% BRCA1-like testing was always cost-effective.Conclusions: Treating TNBC with personalized HDAC based on BRCA1-like testing is expected to be cost-effective at a minimum PPV of 46%. This information can help test developers in decisions on further research and development

    AB - Objectives: Triple negative breast cancers (TNBC) with a BRCA1-like profile may benefit from high dose alkylating chemotherapy (HDAC). This study examines whether treating TNBC with personalized HDAC based on BRCA1-like testing can be more cost-effective than current clinical practice. Additionally we estimated the minimum required prevalence of BRCA1-likeness and the required positive predictive value (PPV) for a BRCA1-like test to render this strategy cost-effective.Methods: Our markov model compared the outcomes of treating TNBC women with personalized HDAC based on BRCA1-like testing vs. current clinical practice from a societal Dutch perspective and a 20-year time horizon. From our base-case model we assessed: 1) the incremental number of respondents; 2) the incremental number of Quality Adjusted Life Years, 3) the incremental costs, and 4) the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis (SA) of all model parameters, and two-way SA of prevalence and PPV. Data were obtained from a current trial (NCT01057069), published literature and expert opinions where necessary.Results: Based on our base-case analysis with 68% BRCA1-like prevalence, 100% PPV, and costs of € 164 / test, treating TNBC according to BRCA1-like testing would be cost-effective (€16.192/QALY). One-way SA on the prevalence and PPV demonstrated that only the PPV drives the ICER changes. In two-way SA, the lower bound for the two parameters was: prevalence 39.6% and PPV 46.4%. Regardless of prevalence, at PPVs > 46.4% BRCA1-like testing was always cost-effective.Conclusions: Treating TNBC with personalized HDAC based on BRCA1-like testing is expected to be cost-effective at a minimum PPV of 46%. This information can help test developers in decisions on further research and development

    KW - METIS-309534

    KW - IR-94668

    U2 - 10.1016/j.jval.2014.08.567

    DO - 10.1016/j.jval.2014.08.567

    M3 - Meeting Abstract

    VL - 17

    SP - A323-A323

    JO - Value in health

    JF - Value in health

    SN - 1098-3015

    IS - 7

    ER -