AI Article Synopsis
- This study investigates the cost-effectiveness of using BRCA1-like testing to determine high dose alkylating chemotherapy (HDAC) for triple negative breast cancer (TNBC) patients compared to standard chemotherapy.
- The analysis revealed that current BRCA1-like testing practices are not cost-effective, with an incremental cost-effectiveness ratio (ICER) higher than the established threshold of €80,000 per Quality Adjusted Life Year (QALY).
- It suggests that for BRCA1-like testing to be considered cost-effective in the future, the positive predictive value (PPV) must reach at least 73%.
Article Abstract
Purpose: Triple negative breast cancers (TNBC) with a BRCA1-like profile may benefit from high dose alkylating chemotherapy (HDAC). This study examines whether BRCA1-like testing to target effective HDAC in TNBC patients can be more cost-effective than treating all patients with standard chemotherapy. Additionally, we estimated the minimum required prevalence of BRCA1-like and the required positive predictive value (PPV) for a BRCA1-like test to become cost-effective.
Methods: Our Markov model compared 1) the incremental costs; 2) the incremental number of respondents; 3) the incremental number of Quality Adjusted Life Years (QALYs); and 4) the incremental cost-effectiveness ratio (ICER) of treating TNBC women with personalized HDAC based on BRCA1-like testing vs. standard chemotherapy, from a Dutch societal perspective and a 20-year time horizon, using probabilistic sensitivity analysis. Furthermore, we performed one-way sensitivity analysis (SA) to all model parameters, and two-way SA to prevalence and PPV. Data were obtained from a current trial (NCT01057069), published literature and expert opinions.
Results: BRCA1-like testing to target effective HDAC would presently not be cost-effective at a willingness-to-pay threshold of €80.000/QALY (€81.981/QALY). SAs show that PPV drives the ICER changes. Lower bounds for the prevalence and the PPV were found to be 58.5% and 73.0% respectively.
Conclusion: BRCA1-like testing to target effective HDAC treatment in TNBC patients is currently not cost-effective at a willingness-to-pay of €80.000/QALY, but it can be when a minimum PPV of 73% is obtained in clinical practice. This information can help test developers and clinicians in decisions on further research and development of BRCA1-like tests.
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| http://dx.doi.org/10.1016/j.breast.2015.03.002 | DOI Listing |
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