title: Cost-utility analyses of drug therapies in breast cancer: a systematic review.
abstract: The economic evaluation (EE) of health care products has become a necessity. Their quality must be high in order to trust the results and make informed decisions. While cost-utility analyses (CUAs) should be preferred to cost-effectiveness analyses in the oncology area, the quality of breast cancer (BC)-related CUA has been given little attention so far. Thus, firstly, a systematic review of published CUA related to drug therapies for BC, gene expression profiling, and HER2 status testing was performed. Secondly, the quality of selected CUA was assessed and the factors associated with a high-quality CUA identified. The systematic literature search was conducted in PubMed, MEDLINE/EMBASE, and Cochrane to identify published CUA between 2000 and 2014. After screening and data extraction, the quality of each selected CUA was assessed by two independent reviewers, using the checklist proposed by Drummond et al. The analysis of factors associated with a high-quality CUA (defined as a Drummond score ≥7) was performed using a two-step approach. Our systematic review was based on 140 CUAs and showed a wide variety of methodological approaches, including differences in the perspective adopted, the time horizon, measurement of cost and effectiveness, and more specially health-state utility values (HSUVs). The median Drummond score was 7 [range 3-10]. Only one in two of the CUA (n = 74) had a Drummond score ≥7, synonymous of "high quality." The statistically significant predictors of a high-quality CUA were article with "gene expression profiling" topic (p = 0.001), consulting or pharmaceutical company as main location of first author (p = 0.004), and articles with both incremental cost-utility ratio and incremental cost-effectiveness ratio as outcomes of EE (p = 0.02). Our systematic review identified only 140 CUAs published over the past 15 years with one in two of high quality. It showed a wide variety of methodological approaches, especially focused on HSUVs. A critical appraisal of utility values is necessary to better understand one of the main difficulties encountered by authors and propose areas for improvement to increase the quality of CUA. Since the last 5 years, there is a tendency toward an improvement in the quality of these studies, probably coupled with economic context, a better and widely spreading of recommendations and thus appropriation by medical practitioners. That being said, there is an urgent need for mandatory use of European and international recommendations to ensure quality of such approaches and to allow easy comparison.
authors: Department of Pharmacy, University Hospital of Besançon, Boulevard Fleming, Besançon, France. v1nerich@chu-besancon.fr.|INSERM, Unit 1098, University of Franche-Comté, Besançon, France. v1nerich@chu-besancon.fr.
authors: Virginie
authors: V
authors: Nerich
authors: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
authors: Sopany
authors: S
authors: Saing
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
authors: Eva Maria
authors: EM
authors: Gamper
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
authors: Georg
authors: G
authors: Kemmler
authors: University Library, University of Franche-Comté, Besançon, France.
authors: Franck
authors: F
authors: Daval
authors: INSERM, Unit 1098, University of Franche-Comté, Besançon, France.|Department of Medical Oncology, University Hospital of Besançon, Besançon, France.
authors: Xavier
authors: X
authors: Pivot
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
authors: Bernhard
authors: B
authors: Holzner
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000235:genetics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy; D019057:Quality-Adjusted Life Years; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*
chemical_list: D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Chemotherapy; Cost–utility analysis; Gene expression profiling; HER2 testing; Hormonotherapy; Quality-adjusted life year; Targeted therapy