Economic Impact of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in France

Abstract

Background and AimsThe heterogeneous nature of breast cancer can make decisions on adjuvant chemotherapy following surgical resection challenging. Oncotype DX is a validated gene expression profiling test that predicts the likelihood of adjuvant chemotherapy benefit in early-stage breast cancer. The aim of this study is to determine the costs of chemotherapy in private hospitals in France, and evaluate the cost-effectiveness of Oncotype DX from national insurance and societal perspectives.MethodsA multicenter study was conducted in seven French private hospitals, capturing retrospective data from 106 patient files. Cost estimates were used in conjunction with a published Markov model to assess the cost-effectiveness of using Oncotype DX to inform chemotherapy decision making versus standard care. Sensitivity analyses were performed.ResultsThe cost of adjuvant chemotherapy in private hospitals was estimated at EUR 8,218 per patient from a national insurance perspective and EUR 10,305 from a societal perspective. Cost-effectiveness analysis indicated that introducing Oncotype DX improved life expectancy (+0.18 years) and quality-adjusted life expectancy (+0.17 QALYs) versus standard care. Oncotype DX was found cost-effective from a national insurance perspective (EUR 2,134 per QALY gained) and cost saving from a societal perspective versus standard care. Inclusion of lost productivity costs in the modeling analysis meant that costs for eligible patients undergoing Oncotype DX testing were on average EUR 602 lower than costs for those receiving standard care.ConclusionsAs Oncotype DX was found both cost and life-saving from a societal perspective, the test was considered to be dominant to standard care. However, the delay in coverage has the potential to erode the quality of the French healthcare system, thus depriving patients of technologies that could improve clinical outcomes and allow healthcare professionals to better allocate hospital resources to improve the standard of care for all patients.

Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011

“…Experience with RS testing in France is similar. 8 In most published clinical series in which RS testing was available, roughly half of patients had a low-risk score, and the median or mean age was in the mid-50s. It is unknown how distributions of scores from previous clinical series compare with the RS distribution in our study population, in which patients were, on average, at least a decade older.…”

“…[1][2][3] Most economic models used to examine the impact of RS testing on overall and chemotherapy-related costs have suggested that RS testing is cost-saving or cost-effective because of net reductions in the use of adjuvant chemotherapy achieved by limiting treatment to patients most likely to benefit. [4][5][6][7][8][9][10][11][12] However, these economic models require numerous assumptions and may be influenced substantially by investigator bias. 13 Furthermore, patients' treatment decisions can vary depending on personal preferences and priorities, and they may not follow test-based or physicianrecommended treatment.…”

Genomic Signatures in Luminal Breast Cancer

“…These genomic tests have the capacity to revolutionize clinical practice. However, extensive gene expression profiling is having an increasing economic impact on the health care system [76]. In a budget impact analysis dif-Breast Care 2020;15:355-365 DOI: 10.1159/000509846 ferent multigene signatures including Oncotype DX ® , MammaPrint ® , Prosigna ® and EndoPredict ® were compared.…”

Systematic review of the clinical and economic value of gene expression profiles for invasive early breast cancer available in Europe

“…Total health care costs may go up or down, depending on the balance between the assay costs and savings on chemotherapy and recurrence. Three studies also included savings on productivity [120][121][122]. Fig.…”