New research published by Dinan et al in JNCCN—Journal of the National Comprehensive Cancer Network provides evidence that genomic recurrence score testing using the 21-gene assay is associated with decreased cancer care costs in real-world practice among certain patients with breast cancer who would otherwise receive standard chemotherapy.
The recurrence score test helps to predict whether or not an individual woman with nonmetastatic breast cancer is likely to benefit from adjuvant chemotherapy.
The study was conducted on data from 30,058 Medicare beneficiaries aged 66–75, diagnosed with estrogen receptor–positive, nonmetastatic, invasive breast cancer between 2005 and 2011. Nearly 18% of patients received recurrence score testing as part of their initial workup; within that group, 13.3% were initially clinically classified as low-risk, 69.5% as intermediate-risk, and 17.2% as high-risk. The data came from a Surveillance, Epidemiology, and End Results and Medicare linked dataset, and costs were calculated by summing Medicare payments from all patient claims and adjusting them to 2013 U.S. dollars.
The team had previously conducted research showing that the recurrence score test leads to a reduction in chemotherapy in women with high-risk disease, suggesting that the test has helped women to opt out of chemotherapy in circumstances where they would have otherwise received it without benefit.
According to study findings, patients identified as clinically high-risk who underwent recurrence score assessment had costs that were roughly $6,600 lower than those who went untested, $3,600 of which was attributable to lower direct chemotherapy costs.
The researchers also found that while recurrence score testing was associated with higher overall costs for patients in the clinically intermediate- and low-risk categories, there were no differences in average chemotherapy costs for these subsets. The increased costs were almost entirely due to higher noncancer costs.
“This study demonstrates that recurrence score testing provides the greatest reduction in costs among patients who, prior to the test, had the highest likelihood of receiving chemotherapy to begin with,” said first author Michaela A. Dinan, PhD, of Duke University. “In the big picture, the ability for recurrence score testing to reduce either the cost of chemotherapy or total health costs may depend on the general distribution of patients who are clinically considered to be high-, intermediate-, or low-risk. This knowledge should help inform a provider’s decision about when recurrence score testing may be most likely to influence treatment choices.”
Dr. Dinan continued, “Our research indicates that selective use of recurrence score testing—particularly for people with clinically-determined high-risk, nonmetastatic breast cancer—provides treatment benefit and cost savings.”
“The NCCN Guidelines recommend strong consideration for the 21-gene assay in patients with estrogen receptor–positive, node-negative, pT1b–pT3 tumors in order to help decide whether or not to add chemotherapy prior to endocrine therapy,” commented Ingrid A. Mayer, MD, MSCI, of Vanderbilt-Ingram Cancer Center, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Breast Cancer. “Despite several limitations and confounding biases for this currently published study, its results are consistent with other studies in the U.S. and around the world. However, the clinical high-risk group—which is most affected by recurrence score testing in this study—represents a minority of patients in that age group. Therefore, it is likely that the larger financial impact of recurrence score would be seen in a younger patient population; which is more likely to present with clinically higher-risk cancers. Ultimately, reducing chemotherapy for that group would not only reduce overall treatment costs, but also spare these patients from being absent from the workforce, which could have a huge impact on individual household finances.”
The study’s authors also noted that because of the older population in this study, chemotherapy rates were significantly lower than previously reported rates. They agreed that recurrence score testing would likely result in an even more dramatic reduction in costs among younger, higher-risk patient populations with higher baseline rates of chemotherapy use.
Disclosure: The study authors' full disclosures can be found at jnccn.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.