Does Oncotype DX–Guided Treatment Reduce Initial Costs of Breast Cancer Care?
A new study suggests that Oncotype DX–guided treatment could reduce the cost for the first year of breast cancer care in the United States by about $50 million (about 2% of the overall costs in the first year). These findings were published by Mariotto et al in the Journal of the National Cancer Institute.
TAILORx and Oncotype DX
The landmark TAILORx (Trial Assigning IndividuaLized Options for Treatment) trial results suggested that use of the Oncotype DX genetic test can offer women valuable information about treatment options, potentially sparing 70% of women from needing chemotherapy if they are newly diagnosed with early-stage breast cancer that is hormone receptor–positive, HER2-negative, and axillary node–negative.
The projected cost savings in the new study are based on two factors: about a 50% increased cost in genetic testing assuming that it will be done for all newly diagnosed women, which would be offset by an approximately 8% expected drop in the overall cost of chemotherapy due to fewer women being recommended this form of treatment.
“Individual women’s decisions should not be about dollars and cents, but what is right for them based on consideration of the best evidence and personal preferences,” said senior study author Jeanne S. Mandelblatt, MD, MPH, Professor of Oncology and Medicine at Georgetown Lombardi Comprehensive Cancer Center.
Study Methods
Researchers examined the monetary impact in the United States of providing care based on evidence from TAILORx. The researchers looked at statistics on genetic testing and chemotherapy use in National Cancer Institute and Medicare databases before and after the TAILORx trial results were announced in 2018.
The periods during which costs accrue are usually grouped into three timeframes: initial costs (diagnosis and treatment), terminal costs (last year of life), and everything in between (continuing care costs). This study only estimated initial costs.
The estimated individual Oncotype DX test costs in this analysis were about $3,400 and based on Medicare reimbursement rates. Many insurers, including Medicare, cover the cost for most women diagnosed with early-stage breast cancer. Another gene test that is used less often in the United States, called MammaPrint, has similar costs.
Costs and Cost Savings
The investigators estimated that, prior to 2018, the mean initial costs of health care nationwide for newly diagnosed women with breast cancer, which were fairly stable for a number of years, included two components: chemotherapy costs of $2.701 billion and Oncotype DX testing costs estimated to be $115 million, for a total health-care cost of $2.816 billion in the first year after diagnosis. The researchers estimated that only 34.8% to 57.2% of women were receiving the Oncotype DX testing in this period, as the clinical application of such tests was still uncertain.
In 2018, the TAILORx findings showed no benefit from chemotherapy for women whose tumors had lower risks for recurrence based on Oncotype DX scores. For their modeling, the researchers projected that all women with scores of 0 to 25 (low- to intermediate-risk) would forgo chemotherapy starting in 2018, so those treatment costs would be reduced by 8%, saving $338 million in initial chemotherapy costs. The researchers also assumed 100% of women would get Oncotype DX testing, raising those costs by $116 million (from $115 million to $231 million). The total initial costs for this period were therefore projected to be $2.766 billion.
Comparing the 2 initial 12-month costs of care for the pre-2018 and 2018-and-after periods, the researchers projected that the combined treatment and testing costs would decrease from $2.816 billion to $2.766 billion, for a net savings of about $50 million (1.8% decrease).
“This study only answers the question about whether, in the first 12 months after diagnosis, costs of gene testing are likely to be offset by savings in avoided costs of chemotherapy—and the answer is yes. We did not estimate how the trial results could diffuse into medical practice, since those data will not be available for several years,” said Dr. Mandelblatt. “The gene tests are not perfect predictors of who will ultimately have a recurrence of breast cancer, so it will be important to model the long-term outcomes and costs from diagnosis to death.”
Disclosure: This work was supported in part by grants from the National Institutes of Health, the National Cancer Institute’s Coordinating Center for Clinical Trials, an American Cancer Society Young Investigator Award, and the Cancer Prevention Research Fellowship sponsored by the American Society of Preventive Oncology and Breast Cancer Research Foundation. For full disclosures of the study authors, visit academic.oup.com.
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®.
