A personal touch - the value of guided treatment in cancer care
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A personal touch - the value of guided treatment in cancer care – Megan Gollings – In the traditional medical model, patients diagnosed with cancer in a particular organ receive the same medication, most often chemotherapy, administered in an average dose. However, many patients don’t respond to this standard approach and when the treatment fails, the physician must return to the drawing board. Personalised medicine aims to minimise this catch-all approach by providing each patient with a specific treatment based on the molecular and genetic characteristics of that patient’s tumour. The approach is gaining momentum and now research presented at the 45th Annual Meeting of the American Society of Clinical Oncology [ASCO; Orlando, Florida, US; May/June 2009] has demonstrated the economic benefits that personalised medicine in cancer care may provide.
Benefits in breast cancer . . .
increase of 0.13 LYs and 0.16 QALYs.
The following studies presented at ASCO focussed on the economic implications of personalised care in breast cancer. In the first study, researchers found that predictive tests for human epidermal growth factor receptor 2 (HER-2) status was an economically favourable strategy to identify patients with breast cancer who would benefit from trastuzumab therapy.1 Using a Markov model with a hypothetical cohort of 10 000 females, with an average age of 50 years, incremental costs were assessed for diagnostic tests and treatments, both in an HER-2 tested and untested arm. Costs were estimated using data from a Swiss third-party payer perspective. Predictive testing using immunohistochemistry and fluorescence in situ hybridisation accounted for €48 and €312, respectively. Trastuzumab administration costs for 1 year were €38 716 per patient. Over a lifetime, there was a total cost difference of €–17 774 in favour of the predictive test strategy. The HER-2 testing strategy was never non-dominant. In another cost-effectiveness analysis, researchers showed that, compared with Adjuvant! Online-guided treatment, Oncotype DX-guided treatment appears cost effective from a Canadian healthcare payer perspective.2 Using a Markov model, they compared treatment guided by either Oncotype DX or Adjuvant! Online in a cohort of 50-year-old women with hormone receptor positive (HR+), lymph node negative (LNN) breast cancer over a lifetime. It was assumed that high-risk women received chemotherapy followed by tamoxifen and that low-risk women received tamoxifen only. Results were reported in 2008 Canadian dollars. Oncotype DX-guided treatment resulted in an incremental lifetime cost of $Can4200 and a gain of 0.067 quality-adjusted life-years (QALYs), with an incremental cost-effectiveness ratio (ICER) of $Can61 800/QALY compared with Adjuvant!-guided therapy. Another screening test, the 70-gene microarray test [MammaPrint], also appears to be cost effective in guiding treatment of early breast cancer, according to US-based researchers at ASCO.3 They used a Markov model with a lifetime horizon to estimate the cost effectiveness
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