Value of information analysis of multiparameter tests for chemotherapy in early breast cancer: the OPTIMA prelim trial

Hall, P. S. et al. (2017) Value of information analysis of multiparameter tests for chemotherapy in early breast cancer: the OPTIMA prelim trial. Value in Health, 20(10), pp. 1311-1318. (doi: 10.1016/j.jval.2017.04.021) (PMID:29241890)

Abstract

Background: Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy. Objectives: To use economic analysis before a large-scale clinical trial of molecular testing to confirm the value of the trial and help prioritize between candidate tests as randomized comparators. Methods: Women with surgically treated breast cancer (estrogen receptor–positive and lymph node–positive or tumor size ≥30 mm) were randomized to standard care (chemotherapy for all) or test-directed care using Oncotype DX™. Additional testing was undertaken using alternative tests: MammaPrintTM, PAM-50 (ProsignaTM), MammaTyperTM, IHC4, and IHC4-AQUA™ (NexCourse Breast™). A probabilistic decision model assessed the cost-effectiveness of all tests from a UK perspective. Value of information analysis determined the most efficient publicly funded ongoing trial design in the United Kingdom. Results: There was an 86% probability of molecular testing being cost-effective, with most tests producing cost savings (range −£1892 to £195) and quality-adjusted life-year gains (range 0.17–0.20). There were only small differences in costs and quality-adjusted life-years between tests. Uncertainty was driven by long-term outcomes. Value of information demonstrated value of further research into all tests, with Prosigna currently being the highest priority for further research. Conclusions: Molecular tests are likely to be cost-effective, but an optimal test is yet to be identified. Health economics modeling to inform the design of a randomized controlled trial looking at diagnostic technology has been demonstrated to be feasible as a method for improving research efficiency.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Iain
• Authors: Hall, P. S., Smith, A., Hulme, C., Vargas-Palacios, A., Makris, A., Hughes-Davies, L., Dunn, J. A., Bartlett, J. M.S., Cameron, D. A., Marshall, A., Campbell, A., Macpherson, I. R., Rea, D., Francis, A., Earl, H., Morgan, A., Stein, R. C., and McCabe, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: Value in Health
• Publisher: Elsevier
• ISSN: 1098-3015
• ISSN (Online): 1524-4733
• Published Online: 11 July 2017
• Copyright Holders: Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
• First Published: First published in Value in Health 20(10): 1311-1318
• Publisher Policy: Reproduced in accordance with the publisher copyright policy