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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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