PRINCE: modelling the cost-effectiveness of prognostic markers in breast cancer

The main objective of this project is to investigate the cost effectiveness of using prognostic information to identify patients who should receive adjuvant therapy for breast cancer. This involves the following:

• identifying prognostic models through systematic review methodology that reliably distinguish clinically important variation in prognosis among groups of women with newly diagnosed breast cancer;
• identifying prognostic factors through systematic review methodology that reliably predict clinically important variation in response [overall survival, disease free survival, mortality] to adjuvant therapy amongst groups of breast cancer patients;
• surveying the current use of prognostic information and use of adjuvant therapy in the UK;
• developing a decision analytic model to integrate the above information with data on costs and quality of life, in order to estimate incremental cost per life year or per quality adjusted life year gained.

Main findings: This work presents a framework for incorporating prognostic information with a health economic decision analytic model. Such a framework is based upon the notion of using a regression based survival model to predict transition probabilities for women with differing prognostic factors, within a Markov model. Alternative ways of using the model’s output as an aid to clinical practice decision making at both the patient and policy making level are presented.

Publications

Williams, C, Brunskill, S, Altman, D, Briggs, A, Campbell, H, Clarke, M, Glanville, J, Gray, A, Harris, A, Johnston, K, and Lodge, M (2006). Cost-effectiveness of using prognostic information to select women with breast cancer for adjuvant systemic therapy. Health Technol Assess 10(34):iii-iv, ix-xi, 1-204.