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Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients

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Abstract

The use of taxanes to treat node-positive (N+) breast cancer patients is associated with heterogeneous benefits as well as with morbidity and financial costs. This study aimed to assess the economic impact of using gene expression profiling to guide decision-making about chemotherapy, and to discuss the coverage/reimbursement issues involved. Retrospective data on 246 patients included in a randomised trial (PACS01) were analyzed. Tumours were genotyped using DNA microarrays (189-gene signature), and patients were classified depending on whether or not they were likely to benefit from chemotherapy regimens without taxanes. Standard anthracyclines plus taxane chemotherapy (strategy AT) was compared with the innovative strategy based on genomic testing (GEN). Statistical analyses involved bootstrap methods and sensitivity analyses. The AT and GEN strategies yielded similar 5-year metastasis-free survival rates. In comparison with AT, GEN was cost-effective when genomic testing costs were less than 2,090€. With genomic testing costs higher than 2,919€, AT was cost-effective. Considering a 30% decrease in the price of docetaxel (the patent rights being about to expire), GEN was cost-effective if the cost of genomic testing was in the 0€–1,139€ range; whereas AT was cost-effective if genomic testing costs were higher than 1,891€. The use of gene expression profiling to guide decision-making about chemotherapy for N+ breast cancer patients is potentially cost-effective. Since genomic testing and the drugs targeted in these tests yield greater well-being than the sum of those resulting from separate use, questions arise about how to deal with extra well-being in decision-making about coverage/reimbursement.

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Acknowledgments

This study was supported by a grant from the “Fondation de France”. The authors thank Dr. Jessica Blanc for revising the English manuscript. The authors also thank Christian de Peretti for valuable discussions about bootstrap.

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Authors and Affiliations

  1. Inserm, UMR 912 “Economic & Social Sciences, Health Systems & Societies”, IRD, 13000, Marseilles, Cedex 9, France

    Patricia Marino & Valérie Seror

  2. Université Aix-Marseille, 13000, Marseilles, France

    Patricia Marino, François Bertucci, Patrice Viens & Valérie Seror

  3. Institut Paoli-Calmettes, 232, Bd de Sainte Marguerite, 13273, Marseilles, France

    Patricia Marino, François Bertucci & Patrice Viens

  4. ERIC EA 3083, University of Lyon (University Claude Bernard Lyon 1), 69622, Lyon, France

    Carole Siani

  5. Centre de Recherche en Cancérologie de Marseille, Département d’Oncologie Moléculaire, Inserm, UMR 891, 13000, Marseille, France

    François Bertucci

  6. IFR137, 13000, Marseille, France

    François Bertucci & Patrice Viens

  7. Institut Claudius Régaud, 31000, Toulouse, France

    Henri Roche

  8. Fédération Nationale des Centres de Lutte Contre le Cancer, 75000, Paris, France

    Anne-Laure Martin

  9. Centre de Recherche en Cancérologie de Marseille, Département d’oncologie médicale, Inserm, UMR 891, 13000, Marseille, France

    Patrice Viens

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  1. Patricia Marino
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Correspondence to Patricia Marino.

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Marino, P., Siani, C., Bertucci, F. et al. Economic issues involved in integrating genomic testing into clinical care: the case of genomic testing to guide decision-making about chemotherapy for breast cancer patients. Breast Cancer Res Treat 129, 401–409 (2011). https://doi.org/10.1007/s10549-010-1242-z

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  • DOI: https://doi.org/10.1007/s10549-010-1242-z

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