title: Cost-effectiveness of the 70-gene signature versus St. Gallen guidelines and Adjuvant Online for early breast cancer.
abstract: BACKGROUND
  The 70-gene signature (MammaPrint) is a prognostic test used to guide adjuvant treatment decisions in patients with node-negative breast cancer. In order to decide upon its use, a systematic comparative analysis of the effects of the 70-gene signature, the Sankt Gallen guidelines and the Adjuvant Online Software for these patients on survival, quality of life and costs is warranted.
  
  
  METHODS
  A Markov decision model was used to simulate the 20-year costs and outcomes (survival and quality-of-life adjusted survival (QALYs)) in a hypothetical cohort of node-negative, estrogen receptor positive breast cancer patients. Sensitivity and specificity of the three prognostic tools were based on 5 and 10 years breast cancer specific survival and distant metastasis as first event, derived from a pooled analysis consisting of 305 tumour samples from 3 previously reported validation studies concerning the 70-gene signature.
  
  
  RESULTS
  Small differences in survival, but substantial differences in quality-adjusted survival between the prognostic tools were observed. Quality-adjusted survival was highest when using the 70-gene signature. Based on costs per QALY, the 70-gene has the highest probability of being cost-effective for a willingness to pay for a QALY higher than euro12.000. Sankt Gallen showed the highest survival rates compared to the 70-gene signature, but leads to a substantial larger amount of adjuvant chemotherapy and lower cost-effectiveness, thus demanding a high willingness to pay to save a life year.
  
  
  CONCLUSIONS
  When deciding upon the cost-effectiveness of the prognostic tests, the 70-gene signature improves quality-adjusted survival and has the highest probability of being cost-effective.
authors.affiliation: Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: Valesca P
authors.initials: VP
authors.lastname: Retèl
authors.forename: Manuela A
authors.initials: MA
authors.lastname: Joore
authors.forename: Michael
authors.initials: M
authors.lastname: Knauer
authors.forename: Sabine C
authors.initials: SC
authors.lastname: Linn
authors.forename: Michael
authors.initials: M
authors.lastname: Hauptmann
authors.forename: Wim H van
authors.initials: WH
authors.lastname: Harten
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000401:mortality; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D008390:Markov Chains; D009367:Neoplasm Staging / Q000191:economics* / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012680:Sensitivity and Specificity