Genomic profile of breast cancer: cost–effectiveness analysis from the Spanish National Healthcare System perspective

Abstract

Background: Cost–effectiveness analysis of MammaPrint^® (70-gene signature) in the diagnosis of early breast cancer as a prognosis assay to study the risk of tumor recurrence to administer adjuvant chemotherapy. Methods: Markov model assuming a cohort of 60-year-old women with breast cancer. Treatment costs and effects were assessed by comparing the 5-year, 10-year and lifetime risk of recurrence using Adjuvant! Online^® (online algorithm), 70-gene signature or Oncotype DX^® (21-gene assay). Results: 70-gene signature showed a life expectancy of 23.55 years at lifetime. Life expectancy was lower for 21-gene assay and online algorithm, with associated quality-adjusted life year gains up to 0.23 and 0.75, respectively, with 70-gene signature. At year 5, the mean cost of 21-gene assay, 70-gene signature and online algorithm was €7100, €6380 and €4580, respectively. 70-gene signature was dominant versus 21-gene assay at any time horizon and would be cost–effective from year 7 versus online algorithm (lifetime: €1457 per quality-adjusted life years gained). Conclusions: 70-gene signature was a dominant strategy over 21-gene assay and was highly cost–effective versus online algorithm.

Keywords::

• breast cancer
• cost–effectiveness
• diagnosis
• genotyping
• MammaPrint^®
• Oncotype DX^®

Financial & competing interests disclosure

This work was supported by Ferrer through an unrestricted grant. J Cortés, MA Seguí and A Lluch contributed to the study as clinical experts. V Becerra, SM Chiavenna and A Gracia work for Ferrer. C Crespo and M Brosa received a grant from Ferrer for the pharmacoeconomic analysis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Breast cancer is the most common tumor type in Spain and the leading cause of cancer death in Spanish women.

• Adjuvant chemotherapy increases survival but at the cost of significant toxicity, which has an impact on the quality of life and the Spanish National Healthcare System budget. Therefore, chemotherapy should be limited to patients with a higher probability of recurrence.

• Gene-expression profiles help identify patients with a higher probability of recurrence and could lead to better resource allocation, reduce unnecessary chemotherapy costs and increase the quality of life.

• Gene-expression profiles are an essential tool for public health decision making in early-stage breast cancer.

• 70-gene signature is a dominant strategy over 21-gene assay in predicting the risk of recurrence and avoiding chemotherapy overtreatment. 70-gene signature is a highly cost–effective strategy versus online algorithm.

Notes