ESTIMATING THE COST-EFFECTIVENESS OF USING CIRCULATING TUMOR CELL DETECTION TO GUIDE SYSTEMIC THERAPY IN STAGE IA PRIMARY BREAST CANCER

Purpose:

Circulating tumour cells (CTCs) in the blood can provide important information regarding prognosis and treatment effectiveness for cancer patients. However, existing tests for detecting CTCs use small blood samples (7,5 mL) and therefore have low sensitivity. Currently a new technique is being developed to separate CTCs in whole blood. This early health technology assessment aims to evaluate the potential impact of using such comprehensive CTC detection technique to guide systemic therapy in stage IA breast cancer in the Netherlands.

Method(s):

The early staging process was identified from the Dutch breast cancer guideline and the group of patients without systemic therapy was defined as the target population. In this population the existing pathway and the pathway including the novel CTC test were presented as flowcharts. Based on these flowcharts, a decision tree combined with a simple Markov model was developed, and used to simulate short and long term health economic outcomes for hypothetical cohorts of women with stage IA breast cancer. Probabilistic sensitivity analysis was performed, on those parameters with enough evidence to define a stochastic distribution, to determine the uncertainty in cost-effectiveness outcomes.

Result(s):

Patients classified with a T0-1N0 mamma carcinoma do not standard receive systemic therapy. In these patients using the novel CTC technique to guide systemic therapy could potentially result in +0,03 QALYs at €8.978 additional cost (incremental cost-effectiveness ratio (ICER) €331.476/QALY) over a time horizon of 5 years. For a life-time horizon these potential benefits are +0,46 QALYs at €8.580 additional cost (ICER €18.737/QALY). The probability that the novel CTC technique would be cost-effective for a Willingness-to-Pay(WTP) of €30,000 per QALY equals 0,0% in a 5 year time horizon and 96,1% for a life time horizon, respectively.

Conclusion(s):

The novel CTC technique may be valuable in guiding decisions regarding additional systemic therapy in patients with stage IA breast cancer. However, the current, limited evidence base suggests that this technique may only be cost-effective when long time horizons are considered. While this technique is developed further, additional evidence should be collected on the expected diagnostic performance, costs, and survival outcomes for patients who are tested positive for CTCs. Such evidence can support the development process and ensure that new tests contribute to the efficient use of healthcare resources.