Gene Assay for Breast Cancer Raises Health Care Costs


A 21-gene assay poses an overall incremental cost increase to the health care system in the short-term, despite lower rates of chemotherapy use, according to a recent study published in the Journal of Clinical Oncology (online December 1, 2017; doi:10.1200/JCO.2017.74.2577).

The 21-gene assay test Oncotype Dx (Genomic Health) is used to aid treatment decision-making regarding chemotherapy use in patients with hormone receptor-positive breast cancer who received endocrine therapy. However, its cost to the health care system is not well known.

For 20 months, Nicole Mittmann, MS, PhD, Sunnybrook Health Sciences Centre (Ontario, Canada), and colleagues observed over 1000 participants enrolled in a field evaluation study. Participants were linked to population-level health system administrative databases.

The researchers calculated overall health system costs and incremental costs, as well as cohort-associated costs, which included the cost of the test, subsequent treatments received, and health care encounters. They also compared the cost in the absence of the test with the pretest recommendation regarding chemotherapy from the field study for a base case and in scenarios reflecting different adjuvant chemotherapy use.

Results of the study showed that the 21-gene assay was associated with a 23% net decrease in chemotherapy use. The base case incremental analysis indicated that the actual overall health system cost of this cohort, which included the cost of the assay, increased by $3.1 million when the test was used ($29.2 million) vs when it wasn’t used ($26.2 million). The actual overall cost to the health system surpassed the estimated cost in the absence of the test in three-of-four scenario analyses.


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The researchers noted that costs increased to $30.2 million when at least 50% of the population was treated with adjuvant chemotherapy.

“The use of real-world administrative data showed that, despite lower rates of chemotherapy use, the 21-gene assay test results in an overall incremental cost to the health care system in the short-term under most assumptions,” the researchers concluded.—Christina Vogt