Ilia L. Ferrusi

Clinical Practice Patterns and Cost Effectiveness of Human Epidermal Growth Receptor 2 Testing Strategies in Breast Cancer Patients

Testing technologies are increasingly used to target cancer therapies. Human epidermal growth factor receptor 2 (HER2) testing to target trastuzumab for patients with breast cancer provides insights into the evidence needed for emerging testing technologies.

Looking back at 10 years of trastuzumab therapy: what is the role of HER2 testing? A systematic review of health economic analyses

Trastuzumab is a targeted therapy for human EGF receptor-2 (HER2)-positive breast cancer. The effectiveness and cost-effectiveness of trastuzumab hinges not only on its clinical efficacy in responding patients, but on the ability to accurately identify appropriate therapeutic candidates. We sought to systematically review the cost-effectiveness of trastuzumab with a focus on the impact of the test(s) used for HER2 diagnosis. Our review included 17 economic evaluations or health technology assessments of trastuzumab therapy or HER2 testing. Trastuzumab was considered cost-effective in all early-stage disease studies, while one author concluded that trastuzumab was not cost-effective for metastatic disease. Only two papers considered the joint effects of test accuracy and sequencing with trastuzumab therapy. These demonstrated that trastuzumab cost-effectiveness is sensitive to HER2-test properties.

Illustrating economic evaluation of diagnostic technologies: comparing Helicobacter pylori screening strategies in prevention of gastric cancer in Canada.

OBJECTIVE The aim of this paper is to present an economic evaluation of diagnostic technologies using Helicobacter pylori screening strategies for the prevention of gastric cancer as an illustration. METHODS A Markov model was constructed to compare the lifetime cost and effectiveness of 4 potential strategies: no screening, the serology test by enzyme-linked immunosorbent assay (ELISA), the stool antigen test (SAT), and the (13)C-urea breath test (UBT) for the detection of H. pylori among a hypothetical cohort of 10,000 Canadian men aged 35 years. Special parameter consideration included the sensitivity and specificity of each screening strategy, which determined the model structure and treatment regimen. The primary outcome measured was the incremental cost-effectiveness ratio between the screening strategies and the no-screening strategy. Base-case analysis and probabilistic sensitivity analysis were performed using the point estimates of the parameters and Monte Carlo simulations, respectively. RESULTS Compared with the no-screening strategy in the base-case analysis, the incremental cost-effectiveness ratio was

Approaches for Economic Evaluations of Health Care Technologies

33,000 per quality-adjusted life-year (QALY) for the ELISA,

Economic evaluation of targeted cancer interventions: critical review and recommendations.

29,800 per QALY for the SAT, and

Do economic evaluations of targeted therapy provide support for decision makers

50,400 per QALY for the UBT. The probabilistic sensitivity analysis revealed that the no-screening strategy was more cost effective if the willingness to pay (WTP) was <

Health technology assessment from a Canadian device industry perspective.

20,000 per QALY, while the SAT had the highest probability of being cost effective if the WTP was >

Central reporting of human epidermal growth factor receptor-2 (HER2) status and adherence to testing and adjuvant trastuzumab treatment guidelines in Ontario.

30,000 per QALY. Both the ELISA and the UBT were not cost-effective strategies over a wide range of WTP values. CONCLUSION Although the UBT had the highest sensitivity and specificity, either no screening or the SAT could be the most cost-effective strategy depending on the WTP threshold values from an economic perspective. This highlights the importance of economic evaluations of diagnostic technologies.

Health Technology Assessment for Radiologists: Basic Principles and Evaluation Framework

Economic evaluations involve the comparison of alternative courses of action in terms of both their costs and their consequences. In response to increasing health care costs, economic evaluations of competing technologies, including radiologic interventions, are increasingly used to inform resource allocation decisions. It is therefore crucial that radiologists have a thorough understanding of the methods. The objective of this paper is to present a detailed overview of the principles and methods of economic evaluations of health technologies, including recent methodologic developments. For the purpose of this paper, the key elements of an economic evaluation are divided into 5 broad sections: 1) types of economic evaluations (eg, cost-effectiveness analysis, cost-utility analysis), 2) study perspectives (ie, temporal and cost perspectives), 3) analysis of costs and effects (eg, incremental cost-effectiveness ratios, cost-effectiveness planes), 4) conducting economic evaluations alongside trials or using decision-analytic models, and 5) dealing with the different forms of uncertainty in economic evaluations (eg, sampling uncertainty in trials, parameter uncertainty in models). Examples from the recent radiology literature are used to explain the key concepts. This review improves upon the previous educational papers published in radiologic journals, as it covers recent methodologic advances regarding the treatment of uncertainty.

Closing the personalized medicine information gap: HER2 test documentation practice

Abstract: Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.