OBJECTIVES: In Finland, breast cancer (BC) patients are typically tested for gene expression of biomarkers such as Ki67, to determine the need for chemotherapy. However, recent studies have highlighted the prognostic limitations of Ki67. In contrast, Sweden and the UK have recommended the use of more advanced genomic tests that provide information about the likelihood of distant recurrence. These tests enable physicians to allocate treatment more efficiently, potentially increasing treatment for those who would benefit and reducing unnecessary treatment. This study aims to assess the cost-utility (CU) of using Prosigna, a genomic test, compared to the current standard practice in guiding adjuvant chemotherapy decisions for early BC management in Finland.

METHODS: A CU analysis was conducted to evaluate the CU of Prosigna in comparison to standard of care as a diagnostic tool to identify molecular higher risk patients that may need chemotherapy treatment to improve prognosis in Finland. The economic model was adapted from the model developed by the External assessment group during the evaluation conducted by National Institute for Health and Care Excellence on tumor profiling tests to guide adjuvant chemotherapy decisions in BC patients. Finnish unit costs were used, however clinical inputs are based on Swedish clinical practice.

RESULTS: The cost-utility analysis demonstrated that Prosigna is likely to be a cost-effective intervention compared to standard practice to avoid systemic adjuvant chemotherapy prescription, based on the individual risk of recurrence, both in node positive and node negative patients.

CONCLUSIONS: The results of the CU analysis highlight that Prosigna should be recommended as a diagnostic tool to improve classification of BC patients into prognostic groups, allowing more precise identification of future recurrence risk and improved basis for adjuvant treatment decisions in Finland.