Result card

  • ECO1: What types of resources are used when delivering uPA/PAI-1 (Femtelle), OncotypeDx™ or MammaPrint® and what types of resources are used when delivering standard clinical practice?
English

What types of resources are used when delivering uPA/PAI-1 (Femtelle), OncotypeDx™ or MammaPrint® and what types of resources are used when delivering standard clinical practice?

Authors: Isaura Vieira, Mirella Corio, Maria Rosaria Perrini, Matteo Ruggeri

Internal reviewers: Hanan Bell, Marco Oradei, Michelle O'Neill, Patricia Harrington, Kristi Liiv

Studies extracted from the basic literature search were analysed. Data from eight studies {1; 2; 3; 4; 5; 7; 8; 9} were found to be relevant to this question. The ORG and TEC domains also provided information relevant to this question.

None

Taking into account the outcomes described in the scope, the resources to be included in the analysis extend beyond those used in the diagnostic process.

Depending on the patient’s risk of recurrence, early invasive breast cancer may be treated, after primary surgery, with adjuvant chemotherapy to prevent or delay distant recurrence {1; 2}. The introduction of prognostic tests that assess the likelihood of breast cancer recurrence {TEC domain} could change the probability of using adjuvant chemotherapy to treat invasive breast cancer. Thus the use of prognostic tests will change the costs associated with treatment and the downstream costs of dealing with any cancer recurrences. It is important to include all the resources used and their costs. The resources used were identified from four main studies {2; 3; 4; 5}.

According to Chen et al. {6} after patients are divided according to risk profiles, they can be assigned to different treatment scenarios: chemotherapy plus endocrine therapy for oestrogen (ER)-positive, high-risk patients; chemotherapy alone for ER-negative, high-risk patients; endocrine therapy alone for ER-positive, low-risk patients; and no adjuvant therapy for ER-negative, low-risk patients. Anti-HER2 (human epidermal growth factor receptor 2) agents (e.g trastuzumab) can be added to chemotherapy depending on the risk classification and HER2 status {3}.

Table 1. Resources identified

Resources

Source

Delivery of prognostic tests

 

Test

TEC domain

Trained resources to collect the tissue samples (nurse and pathologist)

TEC and ORG domain

Adjuvant therapy

 

Endocrine therapy

{2; 3}

Chemotherapy including supportive medications such as antiemetics

{2; 3;7}

Anti-HER2 Agents

{2; 3}

Day care costs

{5}

Treatment for adjuvant chemotherapy toxicity

 

Major resources (includes unplanned hospitalisation)

{2; 3}

Treatment for distant recurrence

 

Endocrine therapy and chemotherapy including supportive medications such as antiemetics

{2; 3;7}

Anti-HER2 Agents

{2; 3}

Monitoring

 

Laboratory test per cycle of chemotherapy

{4}

Follow up of recurrence-free patient

{4}

Follow up of patient with distant recurrence

{4}

Tamoxifen therapy over 5 years

{4}

Medical care for the end of life

{4}


Since few studies have a well-described coverage of the costs included in the model, further information about the resources used in the treatment decisions and treatment of women diagnosed with early invasive breast cancer would be needed to provide an appropriate economic evaluation.

Critical
Completely
Vieira I et al. Result Card ECO1 In: Vieira I et al. Costs and economic evaluation In: Jefferson T, Vicari N, Raatz H [eds.]. Prognostic tests for breast cancer recurrence (uPA/PAI-1 [FEMTELLE], MammaPrint, Oncotype DX ) [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy ; 2013. [cited 7 February 2023]. Available from: http://corehta.info/ViewCover.aspx?id=113

References