Arch Hellen Med, 37(2), March-April 2020, 181-190
Investigation of the cost/effectiveness of the 21 gene reverse transcriptase-polymerase chain reaction assay in breast cancer
O. Siskou,1 D. Κaitelidou,1 P. Galanis,1 N. Kikilias,2 N. Tsoulos,3 O. Konstantakopoulou,1 L. Liaropoulos1
OBJECTIVE To evaluate the economic consequences of the 21 gene reverse transcriptase-polymerase chain reaction (RT-PCR) assay in women with breast cancer for the National Organization for Health Provision (EOPYY).
METHOD A Markov model was developed covering two treatment options for breast cancer: (a) Provision of chemotherapy admission according to common treatment practice, without application of the RT-PCR assay, and (b) provision of chemotherapy depending on the results of the RT-PCR assay. Cost/effectiveness analysis was conducted, using a novel model of progressive deduction based on the volume of RT-PCR examinations. Between January 2014 and May 2018, the RT-PCR test was performed on 1,568 women with breast cancer.
RESULTS Of almost 5,000 women with newly diagnosed breast cancer, 900 to 2,000 women were considered potentially appropriate for RT-PCR testing, with/without the age limitation of 65 years. Only 648/1,568 (41%) of the women who underwent the assay were found to be intermediate and high risk. The total treatment cost for potentially eligible women not undergoing the RT-PCR test (at a conservative estimate of 900 annually) was calculated to be € 6.8 million, while the cost of undertaking the test was calculated to be € 5.4 million annually.
CONCLUSIONS The cost/effectiveness of the RT-PCR test would result in an annual cost savings of almost € 1.4 million and avoidance of unnecessary chemotherapy and associated complications in more than 200 women annually.
Key words: Breast cancer, Chemotherapy, Cost/effectiveness, Gene tests, 21 gene reverse transcriptase-polymerase chain reaction (RT-PCR).