Response-guided neoadjuvant chemotherapy (RG-NACT) is more cost effective than conventional NACT for estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer, according to a study published in BMC Cancer.
Prior studies have shown that RG-NACT is at least as effective as traditional NACT for breast cancer and helps physicians to better tailor therapy based on how tumors respond to treatment. However, this method also comes with additional monitoring costs, which can lead to negative consequences if they are not adequately understood prior to resource implementation.
-----
Related Content
Tumor Genetics Can Change During Treatment for ER+ Breast Cancer
Trastuzumab Cost Effectiveness Varies Based on Hormone Receptor Status
-----
Thus, researchers led by Anna Miquel-Cases, Netherlands Cancer Institute, conducted a study to estimate the expected cost-effectiveness and resource requirements of implementing RG-NACT with MRI (Magnetic resonance imaging) for the treatment of ER-positive/HER2-negative breast cancers in The Netherlands.
They used a Markov model to compare the cost, quality-adjusted-life-years (QALYs) and costs per QALY of RG-NACT and conventional NACT over a period of 5 years. A hypothetical cohort of 6306 patients reflecting the Dutch target population of patients with breast cancer was used to simulate current and full implementation (4% and 100%, respectively).
At a willingness to pay threshold of €20.000/QALY, RG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94% (current) and 95% (full) certainty. While full implementation of RG-NACT in the Dutch target population would require another 5335 MRI examinations and significantly increase the number of needed MRI technologists and breast radiologists, the reduction in additional relapses, cancer deaths, and congestive heart failures would offset these cost increases.
Thus, researchers concluded that though personnel capacity and MRI utilization would need to be intensified, full implementation of RG-NACT is expected to be far more cost effective than conventional NACT.
The study was limited by a number of factors, including the fact that researchers only accounted for direct-medical costs, since other costs are generally less likely to influence decision-making.
