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Revisión de análisis económicos sobre tecnologías emergentes en oncología

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PharmacoEconomics Spanish Research Articles

Resumen

Introducción: Se realiza una revisión sistemática de estudios de evaluación económica sobre la aplicación de la genómica y proteómica en el área oncológica. El objetivo es evaluar tecnologías diagnósticas o terapéuticas emergentes cuyo ratio coste-efectividad permita que sean socialmente aplicables en los diferentes sistemas de salud.

Métodos: Se analizan los estudios relevantes disponibles de los últimos 10 años en las bases de datos Medline, Embase, Cancerlit y Cochrane Library.

Resultados: Se analizaron 14 estudios: 5 sobre cáncer de mama, 8 en neoplasias colorrectales y 1 en neoplasia urológica. De los estudios analizados, 4 fueron estudios de coste-utilidad, 9 fueron de coste-efectividad y 1 fue de minimización de costes.

Discusión: En el contexto del consejo genético del cáncer de mama, el análisis de la secuencia genética del BRCA 1 y 2 obtiene un ratio coste-efectividad favorable. En el cribaje de pacientes con sobreexpresión de la proteína HER-2, la utilización del HercepTest con confirmación mediante FISH ha demostrado mejor ratio coste-efectividad que la utilización aislada de FISH. Los test basados en microarray-test, Oncotype Dx y MammaPrint muestran un gran potencial como herramientas para el análisis del riesgo de recurrencia y perfiles de expresión génica. En el cáncer hereditario colorrectal, la identificación del APC, MSI, y genes MLH1 y MSH2 mediante test específicos mejora la supervivencia y los resultados obtenidos mediante el consejo genéticos de los familiares. En cáncer prostático, los test de ploidía de ADN son relativamente baratos y obtienen resultados de AVAC elevados.

Conclusión: Existe en la actualidad un incremento significativo de estudios de análisis económicos relacionados con aplicaciones en el área de la genómica. Estos estudios constituyen una importante aportación para el trabajo de los gestores y personal sanitario a la hora de decidir la pertinente incorporación de las contribuciones de la genómica en el área de la oncología.

Abstract

Introduction: This is a systematic review of economic studies assessing the use of genomics and proteomics in oncology. The goal is to evaluate emerging diagnostic and therapeutic technologies with a cost-effectiveness ratio that makes them socially acceptable in different health care systems.

Methods: Relevant studies from the past 10 years available at databases like Medline, Embase, Cancerlit, and The Cochrane Library are analyzed.

Results: Fourteen studies were analyzed; 5 focusing on breast cancer, 8 on colorectal neoplasms, and 1 on urologic neoplasms. Four of the studies analyzed were on cost-utility ratios, 9 on cost-effectiveness, and 1 on cost minimization.

Discussion: In the context of genetic breast cancer testing, the assessment of BRCA1 and BRCA2 gene sequence showed a favorable cost-effectiveness ratio. In the screening of patients with HER-2 overexpression, the use of FISHconfirmed HercepTest has shown a much better cost-effectiveness ratio than the use of FISH alone. Microarray, Oncotype Dx, and MammaPrint tests showed great potential for assessing the risk of recurrence and gene expression profiles. In congenital colorectal cancer, identification of APC, MSI, as well as MLH1 and MSH2 gene expression through specific tests helps improve survival as well as the results obtained through genetic testing of relatives. In prostate cancer, DNA Ploidy analyses are relatively inexpensive and render high QALY results.

Conclusion: There has been a significant increase in studies that assess the economic issues related to the application of genomics. These studies represent a great contribution to the work of health care providers and professionals when they have to decide on the pertinent incorporation of the contributions made by genomics to the area of oncology.

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Authors and Affiliations

  1. Fundación Gaspar Casal, General Díaz Porlier 78, 8o A, 28006, Madrid, España

    Luís Quecedo Gutiérrez

  2. Fundación Gaspar Casal, Madrid, España

    Juan Llano del Señarís

  3. Roche Farma España, España

    María Luz Amador

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  1. Luís Quecedo Gutiérrez
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  2. Juan Llano del Señarís
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Correspondence to Luís Quecedo Gutiérrez.

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Gutiérrez, L.Q., del Señarís, J.L. & Amador, M.L. Revisión de análisis económicos sobre tecnologías emergentes en oncología. Pharmacoecon. Span. Res. Artic. 6, 146–158 (2009). https://doi.org/10.1007/BF03320861

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