Analysis Suggests 70-Gene Signature Strategy Is Not Cost-Effective in Adjuvant Decisions in Patients With Node-Negative Breast Cancer
In a French analysis reported in the Journal of Clinical Oncology, Bonastre and colleagues found that use of the 70-gene signature (MammaPrint) was unlikely to be cost-effective in deciding whether to administer adjuvant therapy in patients with node-negative breast cancer. Use of Adjuvant! Online had the greatest likelihood of being the most cost-effective strategy.
Study Details
The analysis involved combining patient-level data from 307 patients not receiving systemic chemotherapy from a multicenter validation study of the 70-gene signature (TRANSBIG) and secondary sources for chemotherapy efficacy, unit costs, and utility values. The adjuvant decision strategies of 70-gene signature, Adjuvant! Online, and chemotherapy for all patients were compared, with costs from the French National Insurance Scheme, life-years, and quality-adjusted life-years being computed for the strategies over a 10-year period.
Analysis in All Node-Negative Cases
Among all patients with node-negative disease, without chemotherapy, 10-year overall survival was 77% and distant metastasis–free survival was 78%. The proportion of high-risk patients was 72% with the Adjuvant! Online strategy and 63% with the 70-gene signature strategy. Within the 10-year time horizon, health outcomes were similar among the three strategies (mean life-years = 7.74–7.77, quality-adjusted life-years = 5.88–5.90).
Mean total costs were €10,743 (95% confidence interval [CI] = €4,578–€35,225€) for the Adjuvant! Online strategy, €12,123 (95% CI = €6,080–€34,189) for the systemic chemotherapy strategy, and €12,780 (95% CI = €6,748–€37,067) for the 70-gene signature strategy. Based on a €50,000 per quality-adjusted life-year willingness-to-pay threshold, the probability of being the most cost-effective strategy was 92% for the Adjuvant! Online strategy, 6% for the systematic chemotherapy strategy, and 2% for the 70-gene signature strategy.
Analysis in Estrogen Receptor–Positive Cases
Among the 69% of patients who also had estrogen receptor–positive disease, overall survival was 82% and distant metastasis-free survival was 83%. Health outcomes were similar with the three strategies (mean life-years = 7.96–8.00, quality-adjusted life-years = 6.05–6.09).
Mean cost was higher with the 70-gene signature strategy (€10,818) than the Adjuvant! Online strategy (€9,059). At a €50,000 per quality-adjusted life-year willingness-to-pay threshold, the probability of being the most cost-effective strategy was 76% for the Adjuvant! Online, 20% for the 70-gene signature, and 4% for the systematic chemotherapy strategy.
The investigators concluded: “Optimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost effective in patients with [node-negative breast cancer].”
The study was supported by the French National Cancer Institute. The authors indicated no potential conflicts of interest.
Julia Bonastre, PhD, of Institut Gustave Roussy, is the corresponding author for the Journal of Clinical Oncology article.
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