| Description |
Traditional prognostic tools tended to overestimate the risk of cancer recurrence and recommend adjuvant chemotherapy plus tamoxifen for most of 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, because of 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. A cost-effectiveness analysis with a 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 female patients with LN-, ER+, HER2- ESBC at the age of 45 were chosen to undergo treatment guided by either 21-gene assay or NCCN guideline Chinese version. Costs were estimated under the Chinese health care system, from the health care provider's perspective, reported in 2008 Chinese Yuan (¥). Total costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) were estimated as outcome measures. Under base case analysis with the AC regimen as adjuvant chemotherapy, 21-gene assay saves ¥11 125 (US$1 628) with a higher QALY of 0.30 year per patient over 10 iv years. Replacing the chemotherapy with TC regimen results in an even larger cost saving of ¥13 285 (US$ 1 934) but less effective gain of 0.24 year. Although overall results were sensitive to the 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 the World Health Organization (WHO). In conclusion, 21-gene assay-guided treatment is considered to have 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 inform better clinical decision making in China. |
