Published Jul 2, 2013

Toronto, ON, Canada – Personalized medicine offers the promise of more effective results through individualized therapy. By tailoring treatments to only those who may benefit, patient outcomes might be improved. However, personalized medicine tests are often expensive. Breast cancer is a complex disease that affects 1 in 9 Canadian women during their lifetime. Studies have shown that 1 in 29 women in Canada will die from it. For patients with early breast cancer, it is often difficult for doctors to decide whether to provide chemotherapy following surgery. This decision is based on clinical judgement, often supplemented by a free online decision aid. A new personalized genomic test allows for more individualized therapy by providing additional information regarding a patient’s risk of cancer recurrence, at a cost of approximately US $4,000 per patient. Researchers at the Toronto Health Economics and Technology Assessment (THETA) Collaborative at the University of Toronto evaluated the cost-effectiveness of using the genomic test, in conjunction with the online decision aid, for patients with early stage breast cancer that is hormone receptor-positive and HER2-negative. The results revealed that using the genomic test is cost-effective. This was the first study to also consider the cost-effectiveness of providing patients with chemotherapy, conditional upon their risk classification. Chemotherapy appears to be cost-effective for patients at intermediate or high risk using the genomic test, although this finding is uncertain for some patients at intermediate risk. Due to its high per-test cost, incorporating the genomic test into the health care system will not reduce costs overall. However, for many patients, the genomic test will show that chemotherapy is unnecessary, eliminating unwarranted treatment and its associated costs, and providing better health outcomes. In other patients, the genomic test will better identify the risk of cancer recurrence and ensure that patients receive the timely and effective treatment that best meets their needs. “Our findings will be of considerable interest to policy makers, health care providers, and clinicians faced with a climate of constrained resources and the difficult decision of whether to provide chemotherapy, particularly to intermediate risk patients,” said Mike Paulden, MSc, a health economist at the THETA Collaborative who led the research. “Despite the high cost of the test, this study suggests that this is a good use of health care dollars. We will continue to refine our analysis as more evidence becomes available on this and other genomic tests.” The full study, “Cost-Effectiveness of the 21-Gene Assay for Guiding Adjuvant Chemotherapy Decisions in Early Breast Cancer,” is published in Value in Health.

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