Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model
2018
Abstract Objective To carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). Method The cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. Results From a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. Conclusions Oncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings.
Keywords:
- Probabilistic analysis of algorithms
- Environmental health
- Risk analysis (engineering)
- Parametric statistics
- Discrete event simulation
- Cost–utility analysis
- Probabilistic logic
- Natural history
- Expected value of perfect information
- Medicine
- Euros
- societal perspective
- cost effectiveness
- Welfare economics
- Nursing
- Oncotype DX
- pais vasco
- cost savings
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
34
References
4
Citations
NaN
KQI