OBJECTIVES: The 21-gene Breast Cancer Test (Oncotype DX®) is a validated diagnostic test that predicts the likelihood of adjuvant chemotherapy benefit and breast cancer recurrence in selected patients with early-stage breast cancer. A previous cost-effectiveness analysis of this test versus standard French clinical practice was published in 2012. Since then, docetaxel is no longer reimbursed on top of the diagnosis related groups (DRGs). The objective of this study was to update the cost-effectiveness analysis considering this change. METHODS: The cost-effectiveness analysis was conducted using a Markov model including three health states (survival without recurrence, metastatic recurrence at ten years and death). Previous cost analyses were updated in order to assess the current overall costs of chemotherapy in public and private hospitals, considering that doxetaxel is not anymore reimbursed on top of DRGs. Unit costs were updated to 2015 values and other model parameters were collected from published literature. This study was conducted from the societal perspective. Deterministic sensitivity analyses were conducted to identify key drivers of the results. RESULTS: Chemotherapy costs (standard deviation) per patient were estimated at €10,917 from the societal perspectivein public hospitals. The incremental number of life years gained over 30 years was 0.15; the incremental number of QALYs gained was 0.14. Using the test was found to be cost-effective versus usual care with a cost per QALY ratio of €3,453 in public hospitals (€4,147 in private) from public perspective and a dominant strategy with a net cost-saving per patient of €658 in public hospitals (€449 in private) when considering costs of absenteeism. CONCLUSIONS: While the cost of chemotherapy decreased considerably after the inclusion of docetaxel in the DRGs, the use of the 21-gene test is still cost-effective compared to usual care in French public and private hospitals from a societal perspective.