masterThesis
Costo-efectividad de la biopsia líquida para definir cambio farmacológico en cáncer de mama HER2 + avanzado en Colombia
Fecha
2019Autor
Sánchez Calderón, Diana Carolina
Pedraza López, Adriana
Mancera Urrego, Catalina
Institución
Resumen
Breast cancer has a high prevalence and incidence worldwide and leads to elevated costs to health systems. The HER2+ subtype is considered a poor-prognosis cancer and accounts for 30% of all breast cancer types. It is associated with resistance to therapies, leading to change in treatment lines. Liquid biopsy is a minimally invasive technique which detects molecular resistance to treatment, even prior to clinical manifestations. It can be used as an alternative to tissue biopsy in breast cancer. Objective: To determine the cost-effectiveness of liquid biopsy to define therapeutic changes in women with advanced HER2+ breast cancer in Colombia. Methodology: a decision tree model and deterministic analisis was perfomed, based on literature about first and second lines of treatment (Trastuzumab, Pertuzumab, Docetaxel and TDM1 respectively), resistance, outcomes, sensitivity and specificity of the test. The effectiveness was measured by QALYs and the costs were obtained from databases of national validity, suppliers, Drug Price Information System (Colombia) and local studies. Results: The use of liquid biopsy added to conventional treatment was more expensive and less effective than conventional treatment without liquid biopsy: US $ 177.985,35 and 0.533889206 QALY. The incremental cost and incremental effectiveness with liquid biopsy were USD $ 7,333.17 and 0.00042256 QALY respectively, in relation to the comparator. Conclusions: The addition of liquid biopsy to conventional treatment in women with advanced breast cancer HER2+ in Colombia was not cost-effective. Additional evidence on the utility of the test is required, according to the financing capacity in Colombia and other countries.