Breast Cancer Research and Treatment

, Volume 133, Issue 3, pp 1115–1123

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

  • Nathan W. D. Lamond
  • Chris Skedgel
  • Daniel Rayson
  • Lynn Lethbridge
  • Tallal Younis
Epidemiology

DOI: 10.1007/s10549-012-1989-5

Cite this article as:
Lamond, N.W.D., Skedgel, C., Rayson, D. et al. Breast Cancer Res Treat (2012) 133: 1115. doi:10.1007/s10549-012-1989-5

Abstract

The 21-gene recurrence score (Oncotype DX®: RS) appears to augment clinico-pathologic prognostication and is predictive of adjuvant chemotherapy benefit in node-negative (N−) and node-positive (N+), endocrine-sensitive breast cancer. RS is a costly assay that is associated with good ‘value for money’ in N− disease, while economic evaluations in N+ disease based on most recent data have not been conducted. We examined the cost-utility (CU) of a RS-guided adjuvant strategy, compared to current practice without RS in N− and N+, endocrine-sensitive, breast cancer from a Canadian health care system perspective. A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALYs) over a 25-year horizon. Patient outcomes with and without chemotherapy in RS-untested cohorts and in those with low, intermediate and high RS were examined based on the reported prognostic and predictive impact of RS in N− and N+ disease. Chemotherapy utilization (current vs. RS-guided), unit costs and utilities were derived from a Nova Scotia Canadian population-based cohort, local unit costs and the literature. Costs and outcomes were discounted at 3% annually, and costs were reported in 2011 Canadian dollars ($). Probabilistic and one-way sensitivity analyses were conducted for key model parameters. Compared to a non-RS-guided strategy, RS-guided adjuvant therapy was associated with $2,585 and $864 incremental costs, 0.27 and 0.06 QALY gains, and resultant CUs of $9,591 and $14,844 per QALY gained for N− and N+ disease, respectively. CU estimates were robust to key model parameters, and were most sensitive to chemo utilization proportions. RS-guided adjuvant therapy appears to be a cost-effective strategy in both N− and N+, endocrine-sensitive breast cancer with resultant CU ratios well below commonly quoted thresholds.

Keywords

Breast cancer21-RS assayCost-utility analysisEconomic evaluationAdjuvant chemotherapy

Supplementary material

10549_2012_1989_MOESM1_ESM.tif (161 kb)
Online Resource Figure 1: Incremental Costs and QALYs in Node-negative and node-positive Breast Cancer. The Y axis shows the incremental costs (in $) associated with RS testing, while the X axis shows the incremental QALYs gained. Abbreviations – RS: recurrence score. QALY: quality-adjusted life year (TIFF 161 kb)
10549_2012_1989_MOESM2_ESM.doc (54 kb)
Supplementary material 2 (DOC 54 kb)
10549_2012_1989_MOESM3_ESM.doc (26 kb)
Supplementary material 3 (DOC 26 kb)

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Nathan W. D. Lamond
    • 1
  • Chris Skedgel
    • 2
  • Daniel Rayson
    • 1
    • 2
  • Lynn Lethbridge
    • 3
  • Tallal Younis
    • 1
    • 2
  1. 1.Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences CentreHalifaxCanada
  3. 3.Department of Community Health and EpidemiologyDalhousie UniversityHalifaxCanada