Oliver Ibarrondo1, Isabel Álvarez-López2, Frederick Freundlich3, Arantzazu Arrospide4, Elena Galve-Calvo5, María Gutiérrez-Toribio6, Arrate Plazaola7, Javier Mar4. 1. AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain. Electronic address: Oliver.IbarrondoOlaguenaga@osakidetza.eus. 2. Medical Oncology Service, Donostia University Hospital, Donostia-San Sebastian, Spain. 3. Faculty of Business, Mondragon University, Oñati, Spain. 4. AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Biodonostia Health Research Institute, Donostia-San Sebastian, Spain; Network for Health Services Research on Chronic Patients (REDISSEC), Kronikgune Group, Bilbao, Spain. 5. Medical Oncology Service, Basurto University Hospital, Bilbao, Spain. 6. Medical Oncology Service, Araba University Hospital, Vitoria-Gasteiz, Spain. 7. Medical Oncology Service, Onkologikoa, Donostia-San Sebastian, Spain.
Abstract
OBJECTIVE: To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). METHOD: The cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. RESULTS: From a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. CONCLUSIONS: Oncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings.
OBJECTIVE: To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). METHOD: The cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. RESULTS: From a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. CONCLUSIONS: Oncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings.
Keywords:
Acceptability curve; Cost-effectiveness; Coste-efectividad; Curva de aceptabilidad; Discrete event simulation; Expected value of perfect information; Genomic test; Oncotype Dx; Simulación de eventos discretos; Test genómico; Valor esperado de la información perfecta
Authors: Vladislav Berdunov; Steve Millen; Andrew Paramore; Jane Griffin; Sarah Reynia; Nina Fryer; Rebecca Brown; Louise Longworth Journal: Clinicoecon Outcomes Res Date: 2022-09-19