Breaking News
September 25, 2018 - Antibiotics best paediatric treatment for children’s chronic wet cough
September 25, 2018 - Looking beyond opioids: Stanford pain psychologist briefs Congress
September 25, 2018 - Organs actively fighting back against autoimmune diseases, finds study
September 25, 2018 - Lancaster professor aims to understand how genes affect smoking cessation
September 25, 2018 - Human-oriented perspective needed to better understand Parkinson’s disease
September 25, 2018 - Physical activity may have beneficial effects for people with rare Alzheimer’s disease
September 25, 2018 - FDA Updates on Valsartan Recalls
September 25, 2018 - 3-D-printed tracheal splints used in groundbreaking pediatric surgery
September 25, 2018 - Who is the designated driver, or proxy, for your health decisions?
September 25, 2018 - New chemo-optogenetic method enables multi-directional activity control of cellular processes
September 25, 2018 - Study explores link between genetic predisposition to Alzheimer’s and cardiometabolic risk factors
September 25, 2018 - NeoTract presents new clinical data from studies of UroLift System for patients with BPH
September 25, 2018 - Statins Improve Long-Term Survival After AAA Repair
September 25, 2018 - Novel brain network linked to chronic pain in Parkinson’s disease
September 25, 2018 - Researchers reassess negative pressure wound therapy as its benefit and harm remain unclear
September 25, 2018 - Older adults with ‘fall plan of care’ less likely to suffer fall-related hospitalizations
September 25, 2018 - FDA lifts partial clinical hold that paused enrollment of new patients in tazemetosta clinical trials
September 25, 2018 - IME Medical Electrospinning establishes state-of-the-art manufacturing lab facilities
September 25, 2018 - Phase 1 and 2 clinical trials of entrectinib drug in ROS1-positive NSCLC show promising results
September 25, 2018 - How to Protect Your Eyesight
September 25, 2018 - Novel approach allows researchers to define how cells in the retina respond to diabetes
September 25, 2018 - Columbia University announces winners of 2018 Louisa Gross Horwitz Prize
September 25, 2018 - Clinical trial investigators found non-compliant with requirement to report results on EU register
September 25, 2018 - Study analyzes quality of protein supplements in function of source, treatment and storage
September 25, 2018 - FDA grants Orphan Drug Designation to Myelo001 for treatment of Acute Radiation Syndrome
September 25, 2018 - U.S. Alzheimer’s Cases to Nearly Triple by 2060
September 25, 2018 - Improving cell replacement therapy for Parkinson’s disease
September 25, 2018 - Genervon reports new findings that drug candidate GM6 attenuates Alzheimer’s disease in mice model
September 25, 2018 - FDA approves new 5 mm diameter drug-eluting stent from Cook Medical
September 25, 2018 - New $17.8 million grant ensures USC at forefront of research on tobacco-related health risks
September 25, 2018 - Researchers analyze response to combination immunotherapy for patients with rare skin cancer
September 25, 2018 - Study sheds light on how brain protein may be involved neurodevelopmental disorders
September 25, 2018 - Where to draw the line on incentives
September 25, 2018 - Solid fuel use linked with increased risk of hospitalization or death from respiratory diseases
September 25, 2018 - ‘Trouble Brewing’ report highlights steps that governments can take to reduce alcohol-related harms
September 25, 2018 - Recurrence risk of VTE appears similar for patients with cancer and those with unprovoked VTE
September 25, 2018 - Global leaders must make bold commitments at first-ever UN tuberculosis summit
September 25, 2018 - Brief sleep intervention works long-term to prevent child obesity
September 25, 2018 - Vaping among kids and teens a growing concern
September 25, 2018 - Public launch of products and application solutions from Porvair Laboratory Division
September 25, 2018 - Harmful H. pylori may play a role in Parkinson’s disease
September 25, 2018 - Researchers develop way to measure different types of fear of falling in patients with Parkinson’s
September 25, 2018 - Fracture causes bone density losses throughout the body
September 25, 2018 - Researchers highlight potential therapy for treating rare, deadly blood-clotting disorder
September 25, 2018 - Hybrid theranostic complex shows high therapeutic efficacy against tumor cells
September 25, 2018 - FDA Issues Statement Reaffirming the Positive Benefit-Risk Profile of Nuplazid (pimavanserin) for Patients with Hallucinations and Delusions Associated with Parkinson’s Disease Psychosis
September 25, 2018 - Toxicological evaluation and dosimetry estimation of potential PET radiotracer
September 25, 2018 - 5 obstacles parents commonly face in child obesity treatment and how to overcome them
September 25, 2018 - Immunologist to study how Chikungunya causes devastating effects in older adults
September 25, 2018 - Rural borderland communities vulnerable to high stress impacting mental and physical health
September 25, 2018 - SNMMI announces recipients of 2018-2020 Wagner-Torizuka Fellowship
September 25, 2018 - Common painkiller not effective in controlling chronic pain after traumatic nerve injury
September 25, 2018 - New therapeutic vaccine helps immune cells fight HPV-related head and neck cancer
September 25, 2018 - Environmentally-induced gene activity influences IQ test performance
September 25, 2018 - Biogen and Eisai announce results of LTE Phase 1b study of aducanumab for treating MCI
September 25, 2018 - FDA Approves Copiktra (duvelisib) Capsules for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Follicular Lymphoma
September 25, 2018 - Medical device company settles US case over false claims
September 25, 2018 - Trying to get answers: One woman’s quest for a diagnosis
September 25, 2018 - Lung cancer patients treated with invasive surgery more likely to become chronic opioid users
September 25, 2018 - Oxford VR raises £3.2m to boost innovation in VR for mental health problems
September 25, 2018 - Gene therapy approach could help treat mitochondrial diseases
September 25, 2018 - Few Yogurt Products Qualify As Low-Sugar
September 25, 2018 - Eye disease can cause blindness, and it’s on the rise
September 25, 2018 - Pawnshop density linked to gun-related suicides, Stanford study finds
September 25, 2018 - Pioneering procedure for common prostate condition offered by The London Clinic
September 25, 2018 - Number of people with respiratory diseases likely to increase if UK air pollution remains unchecked
September 25, 2018 - FARXIGA receives positive results in Phase III DECLARE-TIMI 58 cardiovascular outcomes trial
September 25, 2018 - New program to reduce harmful stress effectively improves mood in cancer patients
September 24, 2018 - Florence’s Lingering Threat: Mold – Drugs.com MedNews
September 24, 2018 - For professional baseball players, faster hand-eye coordination linked to batting performance
September 24, 2018 - Bill for later school start times is defeated, but Stanford sleep specialist isn’t
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Successful recovery from addiction means more than achieving abstinence
September 24, 2018 - New nanoplatform technology may reverse drug-resistance in renal cell carcinoma
September 24, 2018 - October 1918 marks the centenary of Spanish Flu that claimed more lives than World War I
September 24, 2018 - LGBT community reports more number of poor mental health days than general population
September 24, 2018 - New research suggests power of zebrafish as tool for cancer drug discovery
September 24, 2018 - New study finds height as possible risk factor for developing varicose veins
September 24, 2018 - Researchers compare weight loss results of online and in-person diabetes prevention program
September 24, 2018 - New HER2 PET Study Uses Affibody’s ABY-025 Tracer to Individualize Breast Cancer Treatment
Common gene test to predict breast cancer recurrence may not be cost-effective

Common gene test to predict breast cancer recurrence may not be cost-effective

image_pdfDownload PDFimage_print

The most commonly used gene expression profile test used to help predict breast cancer recurrence may not be as cost-effective as once thought, say a team of researchers led by Georgetown Lombardi Comprehensive Cancer Center.

Their study, published January 8 in the Journal of Clinical Oncology (“Cost-Effectiveness of Gene-expression Profile Testing in Community Practice”), is the first to look at the cost effectiveness of the test, Oncotype DX®, in “real world” circumstances. Oncotype DX samples 21 different gene arrays to gauge risk of early stage, favorable prognosis tumors coming back later and spreading to other parts of the body (“distant recurrence”) and can be very useful to help patients and their doctors decide if chemotherapy benefits will outweigh its risks. Patients with results indicating low-risk can consider forgoing chemotherapy, while those with high-risk results are recommended to have chemotherapy.

The new research takes into account who was tested; how many patients were determined by the test to be at high risk of breast cancer recurrence, but did not act on treatment recommendations for chemotherapy; and conversely, how many patients were determined to be at lower risk of recurrence, but chose to get chemotherapy. The study also examined the impact of test accuracy on its cost-effectiveness.

Previous studies of the costs and benefits of Oncotype DX were conducted assuming ideal conditions: all patients got the test, physicians and patients used the test’s score to dictate treatment, and the test had prefect prediction of recurrence. Under such ideal conditions past researchers concluded that the benefit of Oncotype DX was reasonable by current standards relative to its costs (between about $3,500 to $4,200). The new study shows that the less than perfect accuracy is one of the factors that make the test less cost-effective than previously thought.

“As with all new technology, it’s important to assess real-world implementation to ensure what we’re offering patients is useful to them and doesn’t add to the societal and patient cost-burden, which is already very high in cancer care,” says the study’s lead author, Young Chandler, DrPH, MS, MPH, assistant professor of oncology at Georgetown University School of Medicine and a member of Georgetown Lombardi.

“Under idealized conditions, this test is considered cost effective. But by looking at national data, our economic analysis found that the likely cost-effectiveness ratio for Oncotype DX testing in community practice was higher than the ratios for the most commonly accepted diagnostic and preventive interventions,” says the study’s senior author, Jeanne S. Mandelblatt, MD, MPH, professor in the departments of oncology and medicine at Georgetown University School of Medicine and a member of Georgetown Lombardi.

“There has long been ongoing debate about what is good value for the money spent in oncology care. This study suggests that it will be critical to consider actual community practice in making such determinations,” says Mandelblatt.

In this study, investigators looked at the “usual care” costs and effects for patients diagnosed with breast cancer between 2000-2004 (before use of genetic predictive tests) and compared the numbers with patients diagnosed from 2005-2012, when Oncotype DX was available to community physicians. In the usual care scenario, patients could receive chemotherapy or not based on their age and breast cancer stage, and in the Oncotype DX testing period, patients were either tested or not, and received chemotherapy based on age, stage, test use, and test results.

Using population data from the National Cancer Institute along with other large data banks, the research team conducted one hundred million simulations to account for uncertainty, inflation, and the benefit of assurance versus worry, among other variables. They found that community practice Oncotype test rates between 2005-2012 were 24 percent and chemotherapy use rate was 30 percent. Patients younger than age 50 who were tested had lower chemotherapy rates than untested patients. Among older patients, there was more chemotherapy use among tested compared to untested patients. These patterns resulted in a greater proportion of tested patients who were destined to have distant recurrences receiving chemotherapy.

But in community practice, test results also sometimes resulted in decisions contrary to test findings ­-;17 to 26 percent of patients with high-recurrence risk scores did not receive chemotherapy as guidelines recommend, and 8 percent of patients with low-risk scores opted to receive chemotherapy.

The researchers found the cost effectiveness ratio for testing versus usual care (no use of the genetic test) was $188,125 per quality-adjusted life-year (QALY). Cost effectiveness for ideal conditions was $39,496 per QALY (more similar to earlier estimates). In the United States, $50,000 QALY was the first benchmark for where the benefits and usage were thought to be reasonable in relation to what is paid for them. Now, many accept a range of $100,000 to $150,000 per QALY, Mandelblatt says.

In their study, if the test was perfectly accurate, the cost-effectiveness ratio of Oncotype DX would be $28,947 QALY, she says. “But given the impact of other genes and factors not considered by this test, some people with low risk breast cancer will recur, and some people with high risk cancer will never recur, making the test have less-than-perfect accuracy.”

Still, benefits to patients are highest relative to costs in the small proportion of women at highest risk of recurrence that would not otherwise be treated without testing,” Mandelblatt says. “That is where such testing really shines.”

Source:

https://gumc.georgetown.edu/

Tagged with:

About author

Related Articles