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Table 3 Input model parameters

From: Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

Parameter mean SE Parametersa Distribution Source
Clinical data
 Monitoring performanceb (proportions)
  True favourable 0,53 0,04 0,53/0,04 Dirichlet [10]
  True unfavourable 0,24 0,05 0,24/0,05 Dirichlet [10]
  False favourable 0,17 0,07 0,17/0,07 Dirichlet [10]
  False unfavourable 0,07 0,09 0,07/0,09 Dirichlet [10]
 Chemotherapy related toxicities
  Vomiting 3×AC 0,05 0,02 5/98 beta [24]
3×DC 0,24 0,04 24/77 beta [24]
  HFS 3×DC 0,22 0,04 23/80 beta [24]
  Neutropenia 3×AC 0,85 0,04 86/15 beta [24]
3×DC 0,72 0,04 74/29 beta [24]
  Desquamation 3×DC 0,05 0,02 5/98 beta [24]
  CHF 3×AC 0,002 0,20 1/359 beta [23]
6×AC 0,02 0,60 11/349 beta [23]
  AML/MDS 3×AC 0,003 0,001 12/4471 beta [25]
6×AC 0,005 0,001 12/2372 beta [25]
Transition probabilities
 Relapse
  RG-NACT; False favourable/unfavourable Tp1 0,14 0,06 4/24 beta [10]
Tp2 0,29 0,08 8/20 beta [10]
Tp3 0,47 0,09 13/15 beta [10]
Tp4 0,44 0,09 12/16 beta [10]
Tp5 0,40 0,09 11/17 beta [10]
  RG-NACT; True favourable/unfavourable Tp12-5 0,00 NA - fixed assumption
  HR RFS (RG-NACT vs. conventional-NACT) 0,50 0,20 0,50/0,20 Normal truncated assumption
  Conventional-NACT Tp1 0,03 - - - [10]
Tp2 0,06 - - - [10]
Tp3 0,08 - - - [10]
Tp4 0,05 - - - [10]
Tp5 0,04 - - - [10]
Breast cancer specific death
  False favourable/unfavourable Tp1 0,00 NA - fixed assumption
Tp2 0,04 0,02 5/109 beta [27]
Tp3 0,12 0,03 14/100 beta [27]
Tp4 0,06 0,02 7/107 beta [27]
Tp5 0,19 0,04 22/92 beta [27]
  HR BCSS (RG-NACT vs. conventional-NACT) 0,64 0,13 0,64/0,13 normal [11]
  Conventional-NACT Tp1 0,00 NA - fixed assumption
Tp2 0,06 - - - [27]
Tp3 0,19 - - - [27]
Tp4 0,09 - - - [27]
Tp5 0,28 - - - [27]
Utilities
 Chemotherapy 0,62 0,04 94/58 beta [39]
 Neutropenia 0,53 0,01 557/488 beta [40]
 Anxiety 0,68 0,06 40/19 beta [43]
 Vomiting 0,52 0,08 17/16 beta [41]
 HFS 0,50 0,10 12/12 beta [41]
 Desquamation 0,59 0,01 1041/721 beta [40]
 CHF (average grade III/IV) 0,55 - - beta [42]
  CHF grade III 0,59 0,02 360/250 beta [42]
  CHF grade IV 0,51 0,05 52/50 beta [42]
 MDS/MLA 0,26 0,01 500/1423 beta [55]
 DFS 0,80 0,03 196/49 beta [39]
 R (average loco-regional and metastatic) 0,73 - - beta [39]
  Loco-regional relapse 0,68 0,03 226/104 beta [39]
  Metastatic relapse 0,78 0,04 104/30 beta [39]
Scenarios and resource modelling
 Incidental findings      
  All 0,18 0,01 270/1265 beta [29]
  Malign 0,20 0,02 55/270 beta [29]
 MRI contraindications      
  Impaired renal function 0.07 0.1c 0.45/5.54 beta [49]
  Gadolinium allergy 0.0003 0.01d 0.08/29 - [44]
  Body ferrous parts 0.58 0.1 0.26/4.21 beta [45]
  Claustrophobia 0.02 0.1 0.02/0.94 beta [48]
  Uptake 0.04   20-100 % fixed assumption
  MRI technologists with ATS 0.26   - fixed [50]
Costs
 Parameter Unit costs Unit measure Mean resource use Mean cost SEe Distribution Source
Chemotherapy  
 6×AC Doxorubicin €204 90 mg 5,3 €1306 €326 Gamma [31]
Cyclophosphamide €45 1080 mg 6,4 €239 €60 Gamma [31]
Peg-filgrastim €849 1 mg 6 €5096 €1274 Gamma [56]
Pharmacy preparation €45 Per course 6 €267 67 Gamma NKI
Day care €286 Day 6 €1718 €430 Gamma [30]
Oncologist’s visit €109 Visit 6 €653 €163 Gamma [31]
Total     €9279    
 3×AC/3×DC Doxorubicin €204 90 mg 3,2 €653 €163 Gamma [31]
Cyclophosphamide €45 1080 mg 2,7 €120 €30 Gamma [31]
Peg-filgrastim €849 1 mg 3 €2548 €637 Gamma [56]
Docetaxel €959 108 mg 3,3 €3195 €799 Gamma [31]
Capecitabine €27 4500 mg 29,9 €821 €205 Gamma [31]
Pharmacy preparation €45 Per course   €267 €67 Gamma NKI
Day care €286 Day 6 €1718 €430 Gamma [30]
Oncologist’s visit €109 Visit 6 €653 €163 Gamma [31]
Total     €9974    
Monitoring
 MRI scan
 Hospital costs €163 Scan 1 €163 €41 Gamma  
 Specialists fees €52 Scan 1 €52 €13 Gamma  
  Total     €215    
 Confirm incidental findings €149 Episode 1 €149 €37 Gamma  
Chemotherapy related toxicities
 Neutropenia €14397 Episode 1 €14397 €425 Gamma [35]
 Vomiting €92 Episode 1 €92 €23 Gamma [57]
 CHF €18225 Episode 1 €18225 €4556 Gamma [33]
 MDS/MLA €112946 Episode 1 €112946 €28236 Gamma [58, 59]
Health states
 DFS In & out –patient €2793 Episode 1 €2793 €563 Gamma [36]
Drugs €79 Episode 1 €79 €20 Gamma [36]
Total     €2872    
 R Local relapse
 In & out -patient €12497 Episode 1 €12497 €1692 Gamma [36]
 Drugs €2336 Episode 1 €2336 €584 Gamma [36]
Distant metastasis        
 In & out -patient €11645 Episode 1 €11645 €1346 Gamma [36]
 Drugs €5772 Episode 1 €5772 €1443 Gamma [36]
Total     €16125    
 BC death €8296 Episode 1 €8296 €2074 Gamma [36]
  1. Abbreviations: SE standard error, AC cyclophosphamide, doxorubicine; DC docetaxel, capecitabine; HFS hand-food-syndrome, CFH congestive heart failure, AML/ADM acute myeloid leukaemia/myelodysplastic syndrome, MRI magnetic resonance imaging, tp transition probability, HR hazard ratio, RG-NACT response guided neoadjuvant chemotherapy, NACT neoadjuvant chemotherapy, DFS disease free survival, R relapse, RFS relapse free survival, BCSS breast cancer specific survival, BC breast cancer, ATS acute transition symptom, NKI Netherlands Cancer Institute
  2. aDirichlet distribution: mean/SE, Beta distribution: α/β, Normal distribution: mean/SE
  3. bWe derived these proportions with the dataset of Rigter et al., as explained in the section ‘clinical input parameters’ and following the definitions of ‘Table 2’
  4. cWe assumed a SE = 0.1
  5. dWe assumed a SE = 0.01
  6. eWe assumed SE = 0.25 when this was not available from literature
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