Journal article
Cost-Effectiveness Analysis of Biological Signature DCISionRT Use for DCIS Treatment
Clinical breast cancer, v 21(3), pp e271-e278
Jun 2021
PMID: 33218957
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Currently it remains difficult to identify patients most likely to benefit from radiotherapy (RT) for ductal carcinoma-in-situ (DCIS), thus leading to wide variation in practice patterns. The genomic risk assessment tool DCISionRT (PreludeDX) has been validated to prognosticate recurrence risk and predict RT benefit. We aimed to study the cost-effectiveness analysis comparing DCIS treatments based on DCISionRT testing to traditional clinicopathologic risk factors.
A Markov state transition model was constructed to perform a cost-effectiveness analysis comparing breast-conserving surgery with or without RT using DCISionRT testing vs. traditional clinicopathologic risk factors. Clinical parameters were obtained from clinical trial data and cross-validation studies. Cost data were based on 2019 Medicare reimbursement. Incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained comparing DCIS treatments using DCISionRT testing to traditional clinicopathologic risk factors and evaluated with a willingness-to-pay threshold of US$100,000 per QALY gained. To account for uncertainty, 1-way and probabilistic sensitivity analyses were performed.
Base case analysis showed that DCIS management using DCISionRT testing was a cost-effective strategy, resulting in an ICER of $74,331 per QALY gained compared to clinicopathology-based treatment. Model results were sensitive to a variation of the proportion of genomic-high, low-risk patients receiving RT in DCISionRT testing strategy, and changes in DCISionRT testing cost.
DCISionRT testing could potentially be a cost-effective strategy compared to traditional decision making for DCIS treatments, optimizing RT benefit based on an accurate recurrence risk assessment.
We performed a cost-effectiveness analysis comparing ductal carcinoma-in-situ (DCIS) treatments using DCISionRT (PreludeDX) testing to traditional clinicopathologic risk factors. Routine use of DCISionRT to guide DCIS treatment results in cost-effectiveness through increased omission of radiotherapy (RT) in low-risk DCIS patients and improved cost-effectiveness for the use of RT in high-risk patients by isolating subgroups with a larger magnitude of benefit from RT in reducing recurrences.
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Details
- Title
- Cost-Effectiveness Analysis of Biological Signature DCISionRT Use for DCIS Treatment
- Creators
- Hayeon Kim - UPMC Hillman Cancer CenterJohn A. Vargo - UPMC Hillman Cancer CenterKenneth J. Smith - University of PittsburghSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Clinical breast cancer, v 21(3), pp e271-e278
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000663349200019
- Scopus ID
- 2-s2.0-85096372291
- Other Identifier
- 991021897265604721
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- Web of Science research areas
- Oncology