Cost-Effectiveness Analysis of the Oncotype DX Breast Recurrence Score® Test for HR+/HER2- Early-Stage Breast Cancer in the US
Author(s)
Berdunov V1, Cuyun Carter G2, Laws E1, Luo R2, Russell C2, Campbell S2, Force J3, Abdou YG4
1PHMR Ltd, London, UK, 2Exact Sciences, Madison, WI, USA, 3Duke University School of Medicine, Durham, NC, USA, 4UNC School of Medicine, Chapel Hill, NC, USA
OBJECTIVES:
The Oncotype DX Breast Recurrence Score® (RS) test is a multigene assay providing information to personalize treatment plans for patients with HR+/HER2- early-stage breast cancer. As demonstrated in the TAILORx and RxPONDER prospective randomized clinical trials, the Oncotype DX test can identify patients who are unlikely to benefit from adjuvant chemotherapy. The cost-effectiveness of decisions based on the Oncotype DX test compared to clinic-pathologic risk assessment alone was assessed from a US Medicare perspective.METHODS:
A decision-analytic model was developed to simulate the lifetime costs and health outcomes, such as quality-adjusted life-years (QALYs) of treatment decisions in node-negative (N0) or node-positive (N+) HR+/HER2- early breast cancer patients. A decision tree model stratified patients according to RS results for adjuvant treatment assignment per guidelines. The estimated probabilities of chemotherapy assignment with/without having received the Oncotype DX test were obtained from US breast cancer specialists. A Markov model was developed to derive estimated lifetime costs and outcomes of distant recurrence and potential adverse events of chemotherapy using values from published literature. Costs were based on Medicare fee schedules in 2020 US dollars.RESULTS:
Compared to clinic-pathologic risk assessment alone, the decisions based on the Oncotype DX test resulted in lower total lifetime costs, -$8,534 for N0 and -$1,194 for N+, while providing additional QALYs of 0.29 and 0.12 for N0 and N+, respectively. The cost savings were driven by reduced adjuvant chemotherapy use and costs of treating distant recurrence. Increased QALYs were the result of avoiding distant recurrence and long-term consequences of chemotherapy.CONCLUSIONS:
This cost-effectiveness analysis demonstrated that individualized treatment decisions based on the Oncotype DX test dominated clinic-pathologic assessment alone, resulting in substantial cost savings from a Medicare perspective while improving outcomes among patients with HR+/HER2- early-stage breast cancer.Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
EE92
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Diagnostics & Imaging
Disease
Personalized and Precision Medicine