title: Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients.
abstract: Guiding response to neoadjuvant chemotherapy (guided-NACT) allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial).
  
  
  
  As effectiveness was shown in hormone-receptor positive (HR+) early breast cancers (EBC), our decision model compared the health-economic outcomes of treating a cohort of such women with guided-NACT to conventional-NACT using clinical input data from the GeparTrio trial. The expected cost-effectiveness and the uncertainty around this estimate were estimated via probabilistic cost-effectiveness analysis (CEA), from a Dutch societal perspective over a 5-year time-horizon.
  
  
  
  Our exploratory CEA predicted that guided-NACT as proposed by the GeparTrio, costs additional €110, but results in 0.014 QALYs gained per patient. This scenario of guided-NACT was considered cost-effective at any willingness to pay per additional QALY. At the prevailing Dutch willingness to pay threshold (€80.000/QALY) cost-effectiveness was expected with 78% certainty.
  
  
  
  This exploratory CEA indicated that guided-NACT (as proposed by the GeparTrio trial) is likely cost-effective in treating HR+ EBC women. While prospective validation of the GeparTrio findings is advisable from a clinical perspective, early CEAs can be used to prioritize further research from a broader health economic perspective, by identifying which parameters contribute most to current decision uncertainty. Furthermore, their use can be extended to explore the expected cost-effectiveness of alternative guided-NACT scenarios that combine the use of promising imaging techniques together with personalized treatments.
authors.affiliation: Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Miquel-Cases
authors.affiliation: Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Valesca P
authors.initials: VP
authors.lastname: Retèl
authors.affiliation: German Breast Group, Neu-Isenburg, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Lederer
authors.affiliation: German Breast Group, Neu-Isenburg, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: von Minckwitz
authors.affiliation: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, United States of America.
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
authors.affiliation: Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.|University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D003663:Decision Trees; D000077143:Docetaxel; D004317:Doxorubicin / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015233:Models, Statistical; D020360:Neoadjuvant Therapy / Q000191:economics*; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide