Cost-effectiveness of Prosigna for Adjuvant Treatment Decisions in Early Breast Cancer: Healthcare Sector and Societal Perspectives.

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2025-04-15 DOI:10.1016/j.clbc.2025.04.011

Lars Asphaug, Lars A Akslen, Egil S Blix, Beate Boge, Elin F Borgen, Marianne B Brekke, Ragnhild S Falk, Gry A Geitvik, Bjørnar Gilje, Berit Gravdehaug, Anette Heie, Emiel Janssen, Cecilie E Kiserud, Torgunn Kursetgjerde, Anita Langerød, Jon Lømo, Bård Mannsåker, Elin Mortensen, Pernilla Olsson, Alina C Porojnicu, Sunil X Raj, Oluf D Roe, Hege E G Russnes, Helle K Skjerven, Silje Songe-Møller, Magdalena A Vestlid, Hege O Ohnstad, Bjørn Naume

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引用次数: 0

Abstract

Background: Gene expression profiling tests such as the Prosigna-assay are used to aid adjuvant treatment decisions in hormone receptor positive (HR+) HER2 negative (HER2-) early breast cancer (EBC). In this evaluation, the cost-effectiveness of Prosigna against immunohistochemical (IHC) markers including Ki-67, was evaluated from the Norwegian healthcare- and societal perspective.

Materials and methods: The treatment decision impact of Prosigna was tested in the prospective, observational EMIT-1 trial. Using individual data collected the first 12 months post-surgery, a decision model was built to project the economic consequences of using the Prosigna compared to IHC-markers for the adjuvant treatment decisions. Health benefits were measured by cost per quality-adjusted life-years (QALYs) and data on income and welfare benefit was obtained from Statistics Norway.

Results: Of 2,178 HR+/HER2- pN0 EBC patients in the EMIT-1 trial, 1,985 had available health economic data and 1,850 had complete income and welfare benefit records. Including all pN0 patients in the Prosigna-test strategy, the test was above the cost-effective threshold (€26,000; incremental cost-per QALY gained (ICER) €255,622) in a healthcare sector perspective. Incorporating also productivity costs, Prosigna was cost-saving (ICER €-435,677). Restricting Prosigna-testing to patients assessed as clear/uncertain chemotherapy candidates, the strategy was cost-effective in both the healthcare and societal perspective (ICER €8884 and €-620170, respectively).

Conclusions: Using the Prosigna-assay for all HR+/HER2- pN0 EBC patients was not cost-effective from a healthcare perspective, but from the societal perspective it was cost-saving. Selecting patients who are clear/uncertain candidates for chemotherapy based on IHC-classification, Prosigna is cost-effective from both perspectives.

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Prosigna在早期乳腺癌辅助治疗决策中的成本效益：医疗保健部门和社会观点。

背景：基因表达谱检测（如Prosigna-assay）用于辅助激素受体阳性（HR+） HER2阴性（HER2-）早期乳腺癌（EBC）的辅助治疗决策。在这项评估中，从挪威医疗保健和社会的角度评估了Prosigna对抗免疫组织化学（IHC）标志物（包括Ki-67）的成本效益。材料和方法：在前瞻性观察性EMIT-1试验中测试了Prosigna对治疗决策的影响。使用术后前12个月收集的个人数据，建立决策模型，以预测使用Prosigna与ihc标记物进行辅助治疗决策的经济后果。健康福利以每个质量调整生命年（QALYs）的成本来衡量，收入和福利福利的数据来自挪威统计局。结果：在EMIT-1试验的2178例HR+/HER2- pN0 EBC患者中，1985例有可用的健康经济数据，1850例有完整的收入和福利记录。包括Prosigna-test策略中的所有pno患者，该测试高于成本效益阈值(26,000欧元；从医疗保健行业的角度来看，每质量质量增量成本（ICER） 255,622欧元。考虑到生产成本，Prosigna节省了成本（ICER€-435,677）。将prosigna检测限制在被评估为明确/不确定化疗候选人的患者中，该策略在医疗保健和社会角度都具有成本效益（ICER€8884和€620170）。结论：从医疗保健的角度来看，对所有HR+/HER2- pN0 EBC患者使用Prosigna-assay并不具有成本效益，但从社会的角度来看，它是节省成本的。根据ihc分类选择明确/不确定的化疗候选患者，从这两个角度来看，Prosigna都具有成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.