Purpose: Traditional prognostic tool tended to overestimate the risk of cancer recurrence and recommend adjuvant chemotherapy plus tamoxifen for most of the early stage breast cancer (ESBC) patients. 21-gene assay is validated as a better predictor that may support this decision making process. Although the cost-effectiveness of 21-gene assay in developed countries is well researched, with huge differences in epidemiology, treatment and healthcare system, these results cannot be generalized to China easily. This study aimed to evaluate the potential economic impact of incorporating 21-gene assay on Chinese ESBC patients.
Method: A cost-effectiveness analysis with decision tree and Markov model was performed based on the validation studies of 21-gene assay and published literature. A hypothetical cohort of 10,000 Chinese women with LN-, ER+, HER2- ESBC patients at the age of 45 were chosen to under through treatment guided by either 21-gene assay or NCCN guideline Chinese version. Costs were estimated under Chinese health care system, from health care provider perspective, reported in 2008 Chinese yuan (￥). Total costs, Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were estimated as outcome measures.
Result: Under base case analysis with AC regimen as adjuvant chemotherapy, 21-gene assay saves ￥11 125 (US$1 628) with a higher QALY of 0.30 year per patient over 10 years. Replacing the chemotherapy with TC regimen results in an even larger cost saving of ￥13 285 (US$ 1 934) but less effective gain of 0.24 year. Although overall results were sensitive to cost of 21-gene assay and NCCN guideline risk classification accuracy, they were still considered as highly cost-effective, in terms of the threshold defined by WHO.
Conclusion: In conclusion, 21-gene assay-guided treatment is considered cost saving and quality of life gain compared with NCCN guideline-guided treatment from a Chinese health care system perspective. The results of this study should be helpful for health managers in considering expanding 21-gene assay use in China.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making