TY - JOUR T1 - Probabilistic cost-utility analysis and expected value of perfect information for the Oncotype multigenic test: a discrete event simulation model JO - Gaceta Sanitaria T2 - AU - Ibarrondo,Oliver AU - Álvarez-López,Isabel AU - Freundlich,Frederick AU - Arrospide,Arantzazu AU - Galve-Calvo,Elena AU - Gutiérrez-Toribio,María AU - Plazaola,Arrate AU - Mar,Javier SN - 02139111 M3 - 10.1016/j.gaceta.2018.07.012 DO - 10.1016/j.gaceta.2018.07.012 UR - https://gacetasanitaria.org/es-probabilistic-cost-utility-analysis-expected-value-articulo-S0213911118302140 AB - ObjectiveTo carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain). MethodThe cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective. ResultsFrom a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision. ConclusionsOncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings. ER -