OBJECTIVES : Prostate cancer (PCa) is the most frequent type of cancer in German men, approximately 60,000 men are diagnosed with biopsy-proven PCa every year. Treatment options include radical prostatectomy, active surveillance and others. The Oncotype DX Genomic Prostate Score (GPS) assay aids the treatment decision at the time of diagnosis in patients with low-risk or favorable intermediate-risk PCa. The current study investigated the expected costs for the treatment of PCa with and without Oncotype DX testing in Germany over a 5-year time horizon.

METHODS : A structured literature search was conducted to identify the average costs per year and the patient distribution for radical prostatectomy and active surveillance in patients with biopsy-proven PCa in Germany. A budget impact model with an up to 5 years time horizon, based on 48 months prospective clinical data, was constructed to calculate the total costs per average patient for the different treatment arms with and without Oncotype DX GPS assay. The effects of different patient distributions were taken into account: a static and also a dynamic approach (Markov chain) were modeled for switching therapy over time.

RESULTS : Over a time span of 5 years Oncotype DX testing generates savings per average patient of € 2,689 (static) respective € 1,461 (dynamic approach): In this conservative estimate the savings mostly compensate the costs of testing. The cost savings for statutory health insurance are mainly realized year 1 and are primarily driven by avoiding radical prostatectomy, which is 15 times more costly than active surveillance. Results are sensitive to the number of patients switched from prostatectomy to active surveillance.

CONCLUSIONS : The budget impact analysis showed that Oncotype DX testing can make a contribution to save expenses for the health insurance in Germany. Savings are achieved mostly by avoiding radical prostatectomies.