Table 5.
Resource modelling and cost-effectiveness results for the current and full implementation scenarios of response-guided NACT in the Netherlands
| Cost-effectiveness analysis expressed per patient | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Current implementation (4 %) | Full implementation (100 %) | |||||||||||
| Costs (€) | LYs | QALYs | ∆ costs (€) | ∆ QALYs | ICER | Costs (€) | LYs | QALYs | ∆ costs (€) | ∆ QALYs | ICER | |
| RG-NACT disc | 28013 | 4.58 | 3.46 | −13 | 0.005 | dominanta | 27698 | 4.64 | 3.58 | −328 | 0.12 | dominant |
| RG-NACT undisc | 30362 | 4.79 | 3.62 | −14 | 0.005 | dominant | 30021 | 4.85 | 3.74 | −355 | 0.13 | dominant |
| Conventional-NACT disc | 28026 | 4.58 | 3.45 | - | - | - | 28026 | 4.58 | 3.45 | - | - | - |
| Conventional-NACT undisc | 30377 | 4.76 | 3.61 | - | - | - | 30377 | 4.76 | 3.61 | - | - | - |
| One-way and two-way sensitivity analysis | ||||||||||||
| ICER | ICER | ICER | ||||||||||
| HR RFS | HR OS | HR RFS/BCSS | ||||||||||
| 0.1 | €-12857/QALY (cost-effective) | 0.1 | €1190/QALY (cost-effective) | 0.1/0.1 | €-922/QALY (cost-effective) | |||||||
| 1 | €2398/QALY (cost-effective) | 1 | €-10692/QALY (cost-effective) | 1/1 | €1139/QALY (cost-effective) | |||||||
| 1.5 | €9367/QALY (cost-effective) | 1.5 | €-15507/QALY (cost-effective) | 1.5/1.5 | €10299/QALY (cost-effective) | |||||||
| Resource modelling analysis expressed in relation to the Dutch population of ER-positive/HER2-negative breast cancer women (n = 6306)c | ||||||||||||
| Current implementation (16 hospitals, 31 MRIs) | Full implementation (113 hospitals, 148 MRIs) | Transition from current to full implementation | ||||||||||
| Health services required at the country level | ||||||||||||
| No of MRIs scans performed | 218 | 5335 | +5117 | |||||||||
| No of patients scanned per MRI | 7 | 36 | +29 | |||||||||
| Fte MRI technologists | 0.2 | 3.8 | +3.6 | |||||||||
| Fte breast radiologists | 0.02 | 0.4 | +0.4 | |||||||||
| 0.04b (↑121 %) | 0.95b (↑121 %) | |||||||||||
| No of confirmations of incidental findings (using standard imaging) | 38 | 939 | +901 | |||||||||
| Health services required at the hospital level | ||||||||||||
| No of MRIs scans performed per hospital | 14 | 47 | +33 | |||||||||
| No of patients scanned per MRI per hospital | 7 | 36 | +29 | |||||||||
| Fte MRI technologists per hospital | 0.01 | 0.03 | +0.02 | |||||||||
| Fte breast radiologists per hospital | 0.001 | 0.004 | +0.003 | |||||||||
| 0.002b (↑121 %) | 0.001b (↑121 %) | |||||||||||
| Health outcomes gained at the country level | ||||||||||||
| No of relapses prevented | 0.4 | 9 | +9 | |||||||||
| No of breast cancer deaths prevented | 6 | 149 | +143 | |||||||||
| Health outcomes lost at the country level | ||||||||||||
| No of excluded patients due to contraindications | 40 | 971 | +931 | |||||||||
| No of patients with NFS | 0.07 | 2 | +2 | |||||||||
| Fte MRI technologists with acute transient symptom | 0.04 | 0.9 | +1 | |||||||||
| No of patients with CHF | 106 | 83 | −23 | |||||||||
| No of patients with long term AML/ADS | 23 | 21 | −2 | |||||||||
| No of patients with anxiety due to incidental findings | 38 | 939 | +901 | |||||||||
| No of patients with malignant incidental findings | 8 | 192 | +184 | |||||||||
Abbreviations: Disc discounted, undisc undiscounted, No number, Fte full-time equivalent, MRI magnetic resonance imaging, NSF nephrogenic systemic fibrosis, ATS acute transient symptom, CHF chronic heart failure, AML/ADS myelodysplastic syndrome/acute myeloid leukaemia
aRG-NACT is more effective and less costly than conventional NACT
bif radiologists spent 15 min to interpret 1 MRI scan
cWhen possible, figures were rounded to the nearest whole number