Prospective cost-effectiveness analysis of genomic profiling in breast cancer

Eur J Cancer. 2013 Dec;49(18):3773-9. doi: 10.1016/j.ejca.2013.08.001. Epub 2013 Aug 27.

Abstract

Background: The cost-effectiveness of the 70-gene signature (70-GS) (MammaPrint®) has earlier been estimated using retrospective validation data. Based on the prospective 5-year survival data of the microarRAy-prognoSTics-in-breast-cancER (RASTER) study, the aim here was to evaluate the cost-effectiveness reflecting the actual use in clinical practice, including reality-based compliance rates.

Methods: Costs and outcomes (quality-adjusted-life-years (QALYs)) were calculated in node-negative (N-) patients included in the RASTER study (n=427). Sensitivity and specificity of the 70-gene and Adjuvant! Online (AO) were based on 5-year distant-disease-free survival (DDFS). Subgroup analyses were performed for two groups for whom benefit of the 70-gene had earlier been reported: (1) ductal, oestrogen receptor-positive (ER+), tumour diameter 10-30 mm, grade II, age 40-70; (2) ductal, oestrogen receptor-positive, tumour diameter 5-30 mm, grade II/III and age 40-70.

Results: Based on 5-year survival data, the cost-effectiveness of the 70-gene signature versus AO was prospectively confirmed. The total health care costs per patient were €26,786 for the 70-gene and €29,187 for AO. The quality adjusted life years yielded 12.49 and 11.88, respectively. The subgroups retrieved slightly higher life gains and higher costs, but all resulted finally in a favourable position for the 70-gene signature.

Conclusions: The use of the 70-gene signature, as judged appropriate by doctors and patients and supported by a low risk 70-gene signature as an oncological safe choice, was also found to be cost-effective.

Keywords: Adjuvant systemic treatment; Breast cancer; Gene expression profiling; Real world cost-effectiveness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / genetics*
  • Chemotherapy, Adjuvant / economics
  • Cost-Benefit Analysis
  • Female
  • Gene Expression Profiling*
  • Gene Expression Regulation, Neoplastic*
  • Humans
  • Markov Chains
  • Middle Aged
  • Oligonucleotide Array Sequence Analysis / economics
  • Outcome Assessment, Health Care / economics
  • Prognosis
  • Prospective Studies
  • Quality-Adjusted Life Years
  • Receptors, Estrogen / metabolism
  • Risk Assessment / economics
  • Survival Analysis
  • Time Factors
  • Tumor Burden / drug effects

Substances

  • Receptors, Estrogen