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2.  Cost-effectiveness of a 21-gene recurrence score assay versus Canadian clinical practice in women with early-stage estrogen- or progesterone-receptor-positive, axillary lymph-node negative breast cancer 
BMC Cancer  2012;12:447.
Background
A 21-gene recurrence score (RS) assay may inform adjuvant systematic treatment decisions in women with early stage breast cancer. We sought to investigate the cost effectiveness of using the RS-assay versus current clinical practice (CCP) in women with early-stage estrogen- or progesterone-receptor-positive, axilliary lymph-node negative breast cancer (ER+/ PR + LN- ESBC) from the perspective of the Canadian public healthcare system.
Methods
We developed a Markov model to project the lifetime clinical and economic consequences of ESBC. We evaluated adjuvant therapy separately in post- and pre-menopausal women with ER+/ PR + LN- ESBC. We assumed that the RS-assay would reclassify pre- and post-menopausal women among risk levels (low, intermediate and high) and guide adjuvant systematic treatment decisions. The model was parameterized using 7 year follow up data from the Manitoba Cancer Registry, cost data from Manitoba administrative databases, and secondary sources. Costs are presented in 2010 CAD. Future costs and benefits were discounted at 5%.
Results
The RS-assay compared to CCP generated cost-savings in pre-menopausal women and had an ICER of $60,000 per QALY gained in post-menopausal women. The cost effectiveness was most sensitive to the proportion of women classified as intermediate risk by the RS-assay who receive adjuvant chemotherapy and the risk of relapse in the RS-assay model.
Conclusions
The RS-assay is likely to be cost effective in the Canadian healthcare system and should be considered for adoption in women with ER+/ PR + LN- ESBC. However, ongoing assessment and validation of the assay in real-world clinical practice is warranted.
doi:10.1186/1471-2407-12-447
PMCID: PMC3488327  PMID: 23031196
Breast cancer; Chemotherapy; Cost-effectiveness; 21-gene recurrence score assay
3.  Recognizing BRCA gene mutation risk subsequent to breast cancer diagnosis in southwestern Ontario 
Canadian Family Physician  2012;58(5):e258-e266.
Abstract
Objective
To describe the population of women in southwestern Ontario who were diagnosed with potentially preventable BRCA mutation–related breast cancer.
Design
Retrospective chart review.
Setting
The Cancer Genetics Clinic of the London Regional Cancer Program in London, Ont.
Participants
Patients younger than 52 years of age who were referred to the London Regional Cancer Program Cancer Genetics Clinic between 1997 and 2007 for BRCA testing after being diagnosed with breast cancer (N = 1017).
Main outcome measures
The proportion of women with BRCA1 or BRCA2 gene mutations and the proportion of women who would have qualified, based on family cancer history, for referral for genetic counseling and testing before their breast cancer diagnoses.
Results
Among the 1017 women referred for BRCA testing, 63 women younger than 52 years of age who had been diagnosed with breast cancer were found, subsequent to this diagnosis, to have BRCA1 or BRCA2 gene mutations. Of these, 41 (65%) had family cancer histories that would have qualified them for genetic counseling and testing, according to provincial criteria, before their own breast cancer diagnoses. Of the 63 women, most (81%) had been referred for BRCA gene mutation testing by their oncologists or surgeons.
Conclusion
Our results suggest that the diagnosis of breast cancer could have been anticipated, and perhaps in some cases prevented, in up to two-thirds of high-risk women younger than 52 years of age in southwestern Ontario. If the high-risk status of these women had been recognized, they might have had the opportunity to choose genetic counseling, testing, more effective cancer surveillance, and potentially preventive options. The results of this study call for increased public and care provider awareness about hereditary breast cancer risk to promote women’s ability to choose to access genetic counseling.
PMCID: PMC3352812  PMID: 22734169
4.  Tumour dormancy in breast cancer: an update 
Breast Cancer Research  2007;9(3):208.
Delayed recurrences, common in breast cancer, are well explained by the concept of tumour dormancy. Numerous publications describe clinical times to disease recurrence or death, using mathematical approaches to infer mechanisms responsible for delayed recurrences. However, most of the clinical literature discussing tumour dormancy uses data from over a half century ago and much has since changed. This review explores how current breast cancer treatment could change our understanding of the biology of breast cancer tumour dormancy, and summarizes relevant experimental models to date. Current knowledge gaps are highlighted and potential areas of future research are identified.
doi:10.1186/bcr1677
PMCID: PMC1929094  PMID: 17561992
5.  Surgical case costing: trauma is underfunded according to resource intensity weights 
Canadian Journal of Surgery  2002;45(1):57-62.
Objective
To determine whether rate-based funding using resource intensity weights (RIWs) adequately represents trauma case costs.
Design
A prospective time-in-motion resource utilization pilot study to assure the effectiveness of the computerized hospital Transition-One data acquisition system, followed by a retrospective observational case costing study. Patient costs with no identifying data were used, and all costs were tabulated as mean cost per group.
Setting
London Health Sciences Centre, London, Ont., a tertiary care “lead” trauma hospital.
Patients
A modified random selection of 4 control case mix groups (CMGs) of surgical patients for the fiscal year 1996–97. The trauma group was selected as a representative resource-intensive CMG. Each patient was assigned to a CMG by Health Records according to the most responsible diagnosis.
Outcome measures
Total case costs were tabulated for each patient then combined for a mean case cost per CMG. The RIW assignments for each patient were combined to create a mean RIW per CMG and mean length of stay per CMG.
Results
There was no statistically significant difference between the control surgical CMGs and the trauma CMG for mean RIW-adjusted length of stay per CMG, but there was a significant difference (p < 0.0001) between the control CMGs and the trauma CMG for RIW-adjusted mean case cost per CMG.
Conclusions
RIWs underrepresent trauma case costs by a factor of 3.5, which could result in under-funding and potential fiscal difficulties for leading trauma hospitals as has occurred in the United States.
PMCID: PMC3692706  PMID: 11837923

Results 1-5 (5)