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Original Article
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Clinical practice patterns and cost effectiveness of human epidermal growth receptor 2 testing strategies in breast cancer patients†‡
Article first published online: 14 SEP 2009
DOI: 10.1002/cncr.24574
Copyright © 2009 American Cancer Society
Additional Information
How to Cite
Phillips, K. A., Marshall, D. A., Haas, J. S., Elkin, E. B., Liang, S.-Y., Hassett, M. J., Ferrusi, I., Brock, J. E. and Van Bebber, S. L. (2009), Clinical practice patterns and cost effectiveness of human epidermal growth receptor 2 testing strategies in breast cancer patients. Cancer, 115: 5166–5174. doi: 10.1002/cncr.24574
- †
We thank i3 Innovus, Julia Trosman, and the Center for Business Models in Healthcare for their commissioned reports developed for the Department of Clinical Pharmacy at the University of California-San Francisco. We also thank Mr. Kuo Tong, president and founder of Quorum Consulting in San Francisco, California, for the use of results from his poster presentation given at the 2007 Breast Cancer Symposium.
- ‡
Dr. Phillips obtained funding, drafted and revised the manuscript, and provided leadership and supervision in conceptualization and design of the study, acquisition of data, and analysis and interpretation of data. Drs. Liang and Marshall participated in conceptualization and design of the study, acquisition of data, analysis and interpretation of data, supervision, and revisions to the manuscript. Dr. Haas participated in conceptualization and design of the study, analysis and interpretation of the data, and revisions to the manuscript. Drs. Elkin, Hassett, and Brock, and Ms. Van Bebber participated in design of the study, analysis and interpretation of the data, and revisions to the manuscript. Ms Ferrusi participated in design of the study, acquisition of the data, analysis and interpretation of the data, and revisions to the manuscript.
Publication History
- Issue published online: 3 NOV 2009
- Article first published online: 14 SEP 2009
- Manuscript Accepted: 5 FEB 2009
- Manuscript Revised: 16 JAN 2009
- Manuscript Received: 7 NOV 2008
- Abstract
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Keywords:
- personalized medicine;
- targeted therapies;
- genomics;
- HER2;
- trastuzumab;
- breast cancer;
- utilization;
- cost effectiveness;
- clinical practice patterns
Abstract
BACKGROUND:
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.
METHODS:
The authors reviewed literature on HER2 test utilization and cost effectiveness of HER2 testing for patients with breast cancer. They examined available evidence on: percentage of eligible patients tested for HER2; test methods used; concordance of test results between community and central/reference laboratories; use of trastuzumab by HER2 test result; and cost effectiveness of testing strategies.
RESULTS:
Little evidence was available to determine whether all eligible patients are tested, how many are retested to confirm results, and how many with negative HER2 test results still receive trastuzumab. Studies suggested that up to 66% of eligible patients had no documentation of testing in claims records, up to 20% of patients receiving trastuzumab were not tested or had no documentation of a positive test, and 20% of HER2 results may be incorrect. Few cost-effectiveness analyses of trastuzumab explicitly considered the economic implications of various testing strategies.
CONCLUSIONS:
There was little information about the actual use of HER2 testing in clinical practice, but evidence suggested important variations in testing practices and key gaps in knowledge exist. Given the increasing use of targeted therapies, it is critical to build an evidence base that supports informed decision making on emerging testing technologies in cancer care. Cancer 2009. © 2009 American Cancer Society.