Blank, P.R.

Brase, J.

Dubsky, P.

Filipits, M.

Gnant, M.

Gutzwiller, F.

Kronenwett, R.

Lux, M.P.

Schwenkglenks, M.

Szucs, T.D.

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Biomarkers in breast cancer59P HEALTH ECONOMIC ANALYSIS OF GUIDELINE AND GENEEXPRESSION SIGNATURE-BASED RISK STRATIFICATIONOF DISTANT RECURRENCE IN EARLY BREAST CANCERPATIENTSP.R. Blank1, M. Schwenkglenks1, P. Dubsky2, M. Filipits3, F. Gutzwiller1,M.P. Lux4, J. Brase5, R. Kronenwett5, T.D. Szucs1, M. Gnant21Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel,SWITZERLAND, 2Department of Surgery, Medical University of Vienna, Vienna,AUSTRIA, 3Departments of Medicine I, Medical University of Vienna, Vienna,AUSTRIA, 4Dept. of Gynecology, Erlangen University, University Breast Centerfor Franconia, Erlangen, GERMANY, 5Forschung und Entwicklung, SividonDiagnostics GmbH, Cologne, GERMANYIntroduction: In primary, estrogen receptor positive (ER+), HER2- breast cancer(BC), individual risk of distant recurrence determines if patients are recommended toundergo either adjuvant endocrine therapy alone or with additional chemotherapy(CT) to reduce the risk of recurrence. Clinical markers and molecular tests such asEndoPredict (EP, Sividon Diagnostics) can be used to support decision making forBC management.Methods: Using a life-long Markov state transition model, we determined the healtheconomic impact and incremental cost effectiveness ratios (ICERs) of applying theEP gene expression test in combination with three clinical guidelines (German-S3[S3] 2008, NCCN 2007, St.Gallen [SG] 2011) to gain additional prognosticinformation in early ER+ HER2- BC patients. No CT or no test (all CT) served asreference strategies. Information on overall and metastasis-free survival were basedon Austrian Breast & Colorectal Cancer Study Group studies (ABCSG6/8, n = 1619).Effectiveness was assessed in terms of quality-adjusted life-years (QALYs); a disutilityfor CT administration was included. Utilities and unit costs were derived frompublished literature. Costs were assessed from the perspective of the Germanthird-party payer. Costs and effects were discounted by 3%.Results: The average life-long cost per patient ranged from EUR 25’910 (no CT) toEUR 35’997 (all CT). Due to imperfect prognostic value and differences in CT use,the various strategies led to clinical outcomes per patient ranging from 13.11 QALYs(no CT) to 13.17 QALYs (EP alone), respectively. The most favorable incrementalcost-effectiveness ratio was achieved by applying EP to patients who were classified ashigh risk (luminal B) by SG, with EUR69’941/QALY compared to no CT. Comparedto SG alone, the combined strategy with SG/EP would save EUR 3’225 (EUR 33’855vs. EUR 30’088) and gain 0.005 QALYs per patient on average. The combination ofguidelines with EP remained preferable in deterministic and scenario analyses.Conclusion: Our model suggests that combining the SG guideline with EP is themost cost-effective approach in ER+ HER2- BC patients, from the perspective of theGerman health care system.Disclosure: P.R. Blank: The research leading to these results has received fundingfrom the European Community’s Seventh Framework Programme (FP7/2007-2013)under grant agreement No 278659 and Sividon Diagnostics GmbH, Cologne,Germany. M. Schwenkglenks: The research leading to these results has receivedfunding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement No 278659 and Sividon Diagnostics GmbH,Cologne, Germany. P. Dubsky: PD has received honoraria from Sividon DiagnosticsGmbH for lectures concerning Endopredict. M. Filipits: MF has received honorariafrom Sividon Diagnostics GmbH for lectures concerning Endopredict. F. Gutzwiller:The research leading to these results has received funding from the EuropeanCommunity’s Seventh Framework Programme (FP7/2007-2013) under grantagreement No 278659 and Sividon Diagnostics GmbH, Cologne, Germany. J. Brase:JCB is employee of Sividon Diagnostics GmbH R. Kronenwett: RK is employee andshareholder of Sividon Diagnostics GmbH.T.D. Szucs: The research leading to theseresults has received funding from the European Community’s Seventh FrameworkProgramme (FP7/2007-2013) under grant agreement No 278659 and SividonDiagnostics GmbH, Cologne, Germany. All other authors have declared no conflictsof interest.© European Society for Medical Oncology 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology.All rights reserved. For permissions, please email: journals.permissions@oup.com.abstractsAnnals of Oncology 24 (Supplement 3): iii29–iii38, 2013doi:10.1093/annonc/mdt084.7

59PHEALTH ECONOMIC ANALYSIS OF GUIDELINE AND GENE EXPRESSION SIGNATURE-BASED RISK STRATIFICATION OF DISTANT RECURRENCE IN EARLY BREAST CANCER PATIENTS

59PHEALTH ECONOMIC ANALYSIS OF GUIDELINE AND GENE EXPRESSION SIGNATURE-BASED RISK STRATIFICATION OF DISTANT RECURRENCE IN EARLY BREAST CANCER PATIENTS

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