Cost-effectiveness analysis of Oncotype DX from a Brazilian private medicine perspective: a GBECAM multicenter retrospective study
Cost-effectiveness analysis of Oncotype DX from a Brazilian private medicine perspective: a GBECAM multicenter retrospective study
Data
2022
Autores
Oliveira, Leandro Jonata Carvalho
Megid, Thais Baccili Cury
Rosa, Daniela Dornelles
Magliano, Carlos Alberto da Silva
Assad, Daniele Xavier
Argolo, Daniel Fontes
Sanches, Solange Moraes
Testa, Laura
Bines, José
Kaliks, Rafael
Journal Title
Journal ISSN
Volume Title
Publisher
Therapeutic Advances in Medical Oncology
Resumo
Background: Oncotype DX (ODX) is a validated assay for the prediction of risk of recurrence
and benefit of chemotherapy (CT) in both node negative (N0) and 1–3 positive nodes (N1),
hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative
(HER2−) early breast cancer (eBC). Due to limited access to genomic assays in Brazil,
treatment decisions remain largely driven by traditional clinicopathologic risk factors. ODX
has been reported to be cost-effective in different health system, but limited data are available
considering the reality of middle-income countries such as Brazil. We aim to evaluate the
cost-effectiveness of ODX across strata of clinical risk groups using data from a dataset of
patients from Brazilian institutions.
Methods: Clinicopathologic and ODX information were analyzed for patients with T1–T3,
N0–N1, HR+/HER2− eBC who had an ODX performed between 2005 and 2020. Projections of
CT indication by clinicopathologic criteria were based on binary clinical risk categorization
based on the Adjuvant! Algorithm. The ODX score was correlated with the indication of CT
according to TAILORx and RxPONDER data. Two decision-tree models were developed. In
the first model, low and high clinical risk patients were included while in the second, only
high clinical risk patients were included. The cost for ODX and CT was based on the Brazilian
private medicine perspective.
Results: In all, 645 patients were analyzed; 411 patients (63.7%) had low clinical risk and 234
patients (36.3%) had high clinical risk disease. The ODX indicated low (<11), intermediate
(11–25), and high (>25) risk in 119 (18.4%), 415 (64.3%), and 111 (17.2%) patients, respectively.
Among 645 patients analyzed in the first model, ODX was effective (5.6% reduction in CT
indication) though with an incremental cost of United States Dollar (US$) 2288.87 per patient.
Among 234 patients analyzed in the second model (high clinical risk only), ODX led to a 57.7%
reduction in CT indication and reduced costs by US$ 4350.66 per patient.
Conclusions: Our study suggests that ODX is cost-saving for patients with high clinical
risk HR+/HER2− eBC and cost-attractive for the overall population in the Brazilian private
medicine perspective. Its incorporation into routine practice should be strongly considered by
healthcare providers.
Description
Palavras-chave
cost-effectiveness analysis, early breast cancer, gene expression signatures, hormone receptor positive breast cancer, Oncotype DX
Citação
Oliveira LJC, Megid TBC, Rosa DD, Magliano CADS, Assad DX, Argolo DF, Sanches SM, Testa L, Bines J, Kaliks R, Caleffi M, de Melo Gagliato D, Sahade M, Barroso-Sousa R, Corrêa TS, Shimada AK, Batista DN, Musse Gomes D, Cesca MG, Gaudêncio D, Moura LMA, de Araújo JAP, Katz A, Mano MS. Cost-effectiveness analysis of Oncotype DX from a Brazilian private medicine perspective: a GBECAM multicenter retrospective study. Ther Adv Med Oncol. 2022 Dec 26;14:17588359221141760. doi: 10.1177/17588359221141760.