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Cost-effectiveness analysis of strategies for HER2 testing of breast cancer patients in France

Published online by Cambridge University Press:  09 August 2006

Magali Morelle ,
Elodie Haslé ,
Isabelle Treilleux ,
Jean-Philippe Michot ,
Thomas Bachelot ,
Frédérique Penault-Llorca  and
Marie-Odile Carrère
Magali Morelle
Affiliation:
Centre Léon Bérard
Elodie Haslé
Affiliation:
Centre Léon Bérard
Isabelle Treilleux
Affiliation:
Centre Léon Bérard
Jean-Philippe Michot
Affiliation:
Centre Léon Bérard
Thomas Bachelot
Affiliation:
Centre Léon Bérard
Frédérique Penault-Llorca
Affiliation:
Centre Jean Perrin
Marie-Odile Carrère
Affiliation:
Université Claude Bernard (Lyon 1) and Centre Léon Bérard
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Abstract

Objectives: A cost-effectiveness analysis was conducted comparing diagnostic strategies for determining the HER2 status of invasive breast carcinomas, as an indication for trastuzumab at metastatic relapse.

Methods: A decision tree compared five strategies distinguished by (i) the use of immunohistochemical (IHC) and/or fluorescent in situ hybridization (FISH) techniques, and (ii) the test schedule (at initial diagnosis or metastatic relapse). Most cost and effectiveness data came from a French multicentric study of 2,045 patients from eight hospitals. We were not able to select final criteria for trastuzumab effectiveness, because published data rely on IHC techniques not used in France (i.e., HercepTest). We, therefore, selected two intermediate criteria for inappropriate treatment at relapse, that is, patients with HER2-amplified tumors not receiving trastuzumab (Criterion 1) and HER2-nonamplified tumors improperly treated with trastuzumab (Criterion 2). Sensitivity analyses were then performed to assess the robustness of the results to (i) discount rate, (ii) cost of FISH, and (iii) tissue fixation technique.

Results: The strategy using IHC at diagnosis was dominated by the four other strategies. Among these approaches, the only efficient strategy for both criteria was IHC used alone at metastatic relapse; strategies using FISH, or IHC followed by FISH on IHC2+ cases were efficient for Criterion 1, whereas IHC followed by FISH on IHC2+ and 3+ cases was efficient for Criterion 2.

Conclusions: Determining HER2 status at diagnosis, as an indication for trastuzumab at metastatic relapse, incurs substantial incremental costs, which do not appear to be justified. No other strategy can be excluded at first.

Keywords

Cost-effectiveness analysisBreast cancerHER2 status
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 3 , July 2006 , pp. 396 - 401
Copyright
© 2006 Cambridge University Press

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References

Bachelot T, Ray-Coquard I, Coeffic D. 2002 Adjuvant therapy for breast cancer patients: Treatment decision tree from a French cancer network. Bull Cancer. 89: 897– 903.Google Scholar
Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. 1982 A convenient approximation of life expectancy (the “DEALE”). II. Use in medical decision-making. Am J Med. 73: 889– 897.Google Scholar
Bilous M, Dowsett M, Hanna W, et al. 2003 Current perspectives on HER2 testing: A review of national testing guidelines. Mod Pathol. 16: 173– 182.Google Scholar
Denoux Y, Arnould L, Fiche M. 2003 HER2 gene amplification assay: Is CISH an alternative to FISH? Annal Pathol. 23: 617– 622.Google Scholar
Di Leo A, Dowsett M, Horten B, et al. 2002 Current status of HER2 testing. Oncology. 63 (Suppl 1): 25– 32.Google Scholar
Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW. 1997. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press;
Early Breast Cancer Trialists' Collaborative Group. 1998 Polychemotherapy for early breast cancer: An overview of the randomised trials. Lancet. 352: 930– 942.
Early Breast Cancer Trialists' Collaborative Group. 1998 Tamoxifen for early breast cancer: An overview of the randomised trials. Lancet. 351: 1451– 1467.
Elkin EB, Weinstein MC, Winer EP, et al. 2004 HER-2 testing and trastuzumab therapy for metastatic breast cancer: A cost-effectiveness analysis. J Clin Oncol. 22: 854– 863.Google Scholar
Falo C, Moreno A, Lloveras B, et al. 2003 Algorithm for the diagnosis of HER-2/neu status in breast-infiltrating carcinomas. Am J Clin Oncol. 26: 465– 470.Google Scholar
Fisher B, Anderson S, Bryant J. 2002 Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 347: 1233– 1241.Google Scholar
Jacobs TW, Gown AM, Yaziji H, Barnes MJ, Schnitt SJ. 1999 Comparison of fluorescence in situ hybridization and immunohistochemistry for the evaluation of HER-2/neu in breast cancer. J Clin Oncol. 17: 1974– 1982.Google Scholar
Kakar S, Puangsuvan N, Stevens JM, et al. 2000 HER-2/neu assessment in breast cancer by immunohistochemistry and fluorescence in situ hybridization: Comparison of results and correlation with survival. Mol Diagn. 5: 199– 207.Google Scholar
Lebeau A, Deimling D, Silverman ML, et al. 2001 Her-2/neu analysis in archival tissue samples of human breast cancer: Comparison of immunohistochemistry and fluorescence in situ hybridization. J Clin Oncol. 19: 354– 363.Google Scholar
Loprinzi CL, Thome SD. 2001 Understanding the utility of adjuvant systemic therapy for primary breast cancer. J Clin Oncol. 19: 972– 979.Google Scholar
Mason J. 1997 The generalisability of pharmacoeconomics studies. Pharmacoeconomics. 11: 503– 514.Google Scholar
Slamon DJ, Clark GM, Jones LA, et al. 1987 Human breast cancer: Correlation of relapse and survival with amplification of the HER2/Neu oncogene. Science. 235: 177– 182.Google Scholar
Slamon DJ, Godolphin W, Jones LA, et al. 1989 Studies of the HER-2/neu proto-oncogene in human breast and ovarian cancer. Science. 244: 707– 12.Google Scholar
Slamon DJ, Leyland-Jones B, Shak S, et al. 2001 Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 344: 783– 792.Google Scholar
Spath HM, Carrere MO, Fervers B, Philip T. 1999 Analysis of the eligibility of published economic evaluations for transfer to a given health care system. Methodological approach and application to the French health care system. Health Policy. 49: 161– 177.Google Scholar
Svrcek M, Sabourin JC. 2002 Immunohistochemistry and genotype analysis of tumors. First part: Which future for the immunochemical diagnosis of cancer? Ann Pathol. 22: 102– 112.Google Scholar
Tubs RR, Pettay JD, Roche PC. 2001 Discrepancies in clinical laboratory testing of eligibility for trastuzumab therapy: Apparent immunohistochemical false-positives do not get the message. J Clin Oncol. 10: 2714– 2721.Google Scholar
Vang R, Cooley LD, Harrison WR, Reese T, Abrams J. 2000 Immunohistochemical determination of HER-2/neu expression in invasive breast carcinoma. Am J Clin Pathol. 113: 669– 674.Google Scholar
Vincent-Salomon A, MacGrogan G, Couturier J, et al. 2003 Calibration of immunohistochemistry for assessment of HER2 in breast cancer: Results of the French multicentre GEFPICS study. Histopathology. 42: 337– 347.Google Scholar