Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

Abstract

The 21-gene test is a validated multi-gene diagnostic test that predicts chemotherapy (CT) benefit in oestrogen receptor positive (ER+), lymph node-negative (N0) breast cancer (BC) patients (pts). Ireland was the first public health care system to reimburse this test in Europe. Study objectives were to assess the impact of this test on decision-making and to analyse the economic impact of testing. Between October 2011 and February 2013, a national, retrospective, cross-sectional observational study of ER+, N0 BC pts tested with the 21-gene test was conducted. Surveyed breast medical oncologists, provided the assumption for the decision impact analysis that grade (G) 1 pts would not have received CT before testing and G2/3 pts would have received CT before testing. Descriptive statistical analyses were performed. 592 pts were identified; Low, intermediate and high recurrence score were identified in 53, 36 and 10 % pts, respectively. 384 (70 %) pts had G2, 129 (22 %) G3 and 76 (13 %) G1 tumours. Post testing, 345 pts (59 %) experienced a change in CT decision; 339 changed to hormone therapy alone and 6 advised to receive CT. 172 (30 %) pts received CT, 12 (3.9 %) of pts with low scores, 108 (50.9 %) of intermediate risk and 50 (90.9 %) of pts with high risk scores. Net reduction in CT use was 58 % and net savings achieved were €793,565. Since public reimbursement, the introduction of the 21-gene test has resulted in a significant reduction in chemotherapy administration and cost savings for the Irish public healthcare system.

Correlation between Oncotype DX, PREDICT and the Nottingham Prognostic Index: Implications for the management of early breast cancer

“…ODX was found to be a more accurate predictor of relapse than standard clinical features for individual patients [16]. Furthermore, ODX testing has been shown to result in cost-savings and a significant reduction in chemotherapy administration [7,17]. A metaanalysis by Carlson et al reported that ODX testing changed treatment decisions for 49% of the patients [15].…”

The American Joint Commission Cancer 8th Edition Prognostic Stage Including Oncotype DX® Recurrence Score: Impact on Staging of Early Breast Cancer

“…Disparity in staging and loss of information internationally will inevitably result from unequal access to biomarker studies. Within the more developed countries, variable access to multigene panels and economic considerations [40] will lead to differences in stage even with adoption of this new approach to BC. The availability of multiple genomic assays with varying concordance for individual patients is another confounding factor [41-45].…”

Prevention, Early Dialogue and Education in the Personalised Healthcare Era

“…[9]. Prevention of chronic diseases could generate substantial savings on the healthcare budget, and make a positive impact on business and the economy, by prolonging healthy working life and reducing the impact of ill health on the labour market [10]. …”