Introduction: 

Cancer patients are at a higher risk of financial difficulty given the rising cost of cancer related treatments, procedures and tests which are routinely ordered by oncologists. 

Objectives 

We sought to perform a cost-effectiveness analysis of universal baseline left ventricular function (LVEF) assessment prior to administration of anthracycline therapy.

Methods 

We performed a retrospective analysis of the Yale Nuclear Cardiology Database, including 702 patients with baseline equilibrium radionuclide angiography scan prior to anthracycline and/or trastuzumab therapy. Univariate and multivariate analyses were performed to assess association between abnormal baseline LVEF (<50%) and potential cardiac risk factors. Additionally, we designed a Markov model to determine the incremental cost-effectiveness ratio (ICER) of LVEF screening for women aged 55 with stage I-III breast cancer from a payer perspective over a lifetime horizon.

Results 

An abnormal LVEF was observed in 2% (n=14) of patients. There were no significant associations on multivariate analysis performed on self-reported risk factors. Our analysis showed LVEF screening is cost effective with ICER of $45,473 per QALY gained. For a willingness-to-pay threshold of $100,000/ QALY, LVEF screening had an 81.9% probability of being cost-effective. Under the same threshold, screening was cost-effective for non anthracycline cardiotoxicity risk of RR ≤ 0.58, as compared to anthracycline regimens.

Conclusions 

Age, pre-existing cardiac risk factors and coronary artery disease did not predict a baseline abnormal LVEF.  While the prevalence of an abnormal baseline LVEF is low in patients with breast cancer, our results suggest that universal baseline cardiac screening prior to anthracycline therapy is cost effective.

01 / EXAMINING THE COST-EFFECTIVENESS OF BASELINE LEFT VENTRICULAR FUNCTION ASSESSMENT AMONG BREAST CANCER PATIENTS UNDERGOING ANTHRACYCLINE BASED THERAPY