Ökonomische Betrachtung von Genexpressionstests beim Mammakarzinom am Beispiel des Oncotype DX^®

Zusammenfassung

Zielsetzung Das Ziel der Übersichtsarbeit ist, die ökonomischen Auswirkungen von Genexpressionstests in der Therapie des frühen, Hormonrezeptor-positiven, Her2-negativen Mammakarzinoms zur Unterstützung der adjuvanten Therapieentscheidung am Beispiel des Oncotype DX^® (ODX) zu erläutern. Im Fokus steht dabei, inwiefern dieser Genexpressionstest zu Kosteneinsparungen führt und ob er als kosteneffektiv bewertet werden kann.

Methodik In gängigen Literaturdatenbanken wurde eine Literaturrecherche zu gesundheitsökonomischen Analysen des ODX durchgeführt. Die Ergebnisse der eingeschlossenen Publikationen wurden ausgewertet und in einem narrativen Review zusammengefasst. Zusätzlich erfolgte eine separate Betrachtung im Kontext des deutschen Gesundheitssystems.

Ergebnisse Es konnten insgesamt 28 Arbeiten identifiziert werden, die sich mit der Wirtschaftlichkeit des ODX auseinandersetzen. Darunter waren 18 Kosten-Effektivitäts-Analysen, 5 Budget-Impact-Analysen sowie 5 Reviews. Die eingeschlossenen Kosten-Effektivitätsanalysen bewerteten den Test insgesamt als kosteneffektiv gegenüber der Regelversorgung, begründet durch ein verbessertes Outcome, eine geringere Anzahl an durchgeführten Chemotherapien, eine geringere Rezidivrate sowie eine höhere Lebenserwartung der Patientinnen. In Abhängigkeit vom jeweiligen Gesundheitssystem wird dem ODX in den Budget-Impact-Analysen ein Einsparpotenzial zugesprochen, teilweise kann es jedoch zu (kurzfristigen) Kostensteigerungen aufgrund der Kosten für die Testung kommen. Die Publikationen zur Wirtschaftlichkeit des ODX im deutschen Versorgungskontext berichten ebenfalls ein Einsparpotenzial.

Schlussfolgerung Die Ergebnisse lassen sich aufgrund unterschiedlicher monetärer Bewertungen zwar nur eingeschränkt auf das deutsche Gesundheitssystem übertragen, es kann dennoch davon ausgegangen werden, dass der Einsatz des ODX auch hier im Längsschnitt zu Kosteneinsparungen führen wird. Eine Erstattung von Genexpressionstests beim frühen Mammakarzinom im Rahmen der Regelversorgung ist demnach unter ökonomischen Gesichtspunkten sinnvoll.

Abstract

Aim The aim of this overview is to explain the economic effects of gene expression tests in the treatment of early, hormone receptor-positive, Her2-negative breast cancer to support adjuvant therapy decisions applying Oncotype DX^® (ODX). The focus is on the extent to which this gene expression test leads to cost savings and whether it can be evaluated as cost-effective.

Method A literature search on health economic analyses of the ODX was conducted in current literature databases. The results of the included publications were evaluated and summarized in a narrative review. In addition, a separate consideration was made in the context of the German healthcare system.

Results A total of 28 papers dealing with the economic efficiency of the ODX were identified. These included 18 cost effectiveness analyses, 5 budget impact analyses and 5 reviews. The cost effectiveness analyses included evaluated the test as cost-effective overall compared to standard care, due to an improved outcome, a lower number of chemotherapies performed, a lower recurrence rate and a longer life expectancy of the patients. Depending on the respective health care system, the ODX is assigned a savings potential in the budget impact analyses; however, in some cases (short-term) cost increases may occur due to the cost of testing. The publications on the cost-benefit relation of the ODX in the German healthcare system also report potential savings.

Conclusion Although the results can only be applied to the German healthcare system to a limited extent due to different monetary assessments, but it can be assumed that the use of the ODX will also lead to long-term cost savings. An introduction of gene expression tests in early breast cancer into standard care is therefore advisable from an economic point of view.

Schlüsselwörter

Brustkrebs - 21 Gen-Expressionstest - Oncotype DX - ökonomischer Review - Kosten-Effektivität

Key words

breast cancer - 21-gene expression assay - Oncotype DX - economic review - cost-effectiveness

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