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Cost-effectiveness analysis of multigene expression profiling assays to guide adjuvant therapy decisions in women with invasive early-stage breast cancer

The Pharmacogenomics Journal volume 20, pages 27–46 (2020)Cite this article

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Abstract

Gene expression profiling (GEP) testing using 12-gene recurrence score (RS) assay (EndoPredict®), 58-gene RS assay (Prosigna®), and 21-gene RS assay (Oncotype DX®) is available to aid in chemotherapy decision-making when traditional clinicopathological predictors are insufficient to accurately determine recurrence risk in women with axillary lymph node-negative, hormone receptor-positive, and human epidermal growth factor-receptor 2-negative early-stage breast cancer. We examined the cost-effectiveness of incorporating these assays into standard practice. A decision model was built to project lifetime clinical and economic consequences of different adjuvant treatment-guiding strategies. The model was parameterized using follow-up data from a secondary analysis of the Anastrozole or Tamoxifen Alone or Combined randomized trial, cost data (2017 Canadian dollars) from the London Regional Cancer Program (Canada) and secondary Canadian sources. The 12-gene, 58-gene, and 21-gene RS assays were associated with cost-effectiveness ratios of $36,274, $48,525, and $74,911/quality-adjusted life year (QALY) gained and resulted in total gains of 379, 284.3, and 189.5 QALYs/year and total budgets of $12.9, $14.2, and $16.6 million/year, respectively. The total expected-value of perfect information about GEP assays’ utility was $10.4 million/year. GEP testing using any of these assays is likely clinically and economically attractive. The 12-gene and 58-gene RS assays may improve the cost-effectiveness of GEP testing and offer higher value for money, although prospective evidence is still needed. Comparative field evaluations of GEP assays in real-world practice are associated with a large societal benefit and warranted to determine the optimal and most cost-effective assay for routine use.

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Acknowledgements

The ATAC trial investigators provided some summary statistical estimates for this research. The results and conclusions are those of the authors, and no official endorsement by ATAC trial investigators is intended or should be inferred.

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Authors and Affiliations

  1. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Malek B. Hannouf & Muriel Brackstone

  2. Ivey School of Business, Western University, London, ON, Canada

    Gregory S. Zaric

  3. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Gregory S. Zaric

  4. London Regional Cancer Program, Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Phillip Blanchette, Jacques Raphael & Muriel Brackstone

  5. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Christine Brezden-Masley

  6. Division of Hematology and Oncology, St. Michael’s Hospital, Toronto, ON, Canada

    Christine Brezden-Masley

  7. School of Public Health, University of Alberta, Edmonton, AB, Canada

    Mike Paulden

  8. The Institute of Health Economics, Edmonton, AB, Canada

    Christopher McCabe

  9. Faculty of Medicine, Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada

    Christopher McCabe

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Hannouf, M.B., Zaric, G.S., Blanchette, P. et al. Cost-effectiveness analysis of multigene expression profiling assays to guide adjuvant therapy decisions in women with invasive early-stage breast cancer. Pharmacogenomics J 20, 27–46 (2020). https://doi.org/10.1038/s41397-019-0089-x

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