Using genetic testing for women newly diagnosed with breast cancer can decrease the high cost of chemotherapy use in the first year of care.
The use of cancer prognostic tests, such as Oncotype DX genetic testing, can lower the initial cost of early breast cancer care in the United States by approximately $50 million, according to a new study published in JNCI.
Many breast cancer therapy options, such as chemotherapy, can be costly; however, some patients who opt to undergo this treatment within the first year of their diagnosis may experience no benefit. Genetic testing can provide valuable information to identify whether patients will require certain therapies and guide treatment options for women diagnosed with breast cancer.
The study, which was led by researchers from Georgetown Comprehensive Cancer Center and National Cancer Institute, examined the effect of providing care based on evidence from the results of Trial Assigning IndividuaLized Options for Treatment (TAILORx). To determine this, the researchers analyzed statistics on gene testing and chemotherapy use in the National Cancer Institute and Medicare databases before and after the TAILORx results were announced. The study estimated the initial costs of diagnosis and treatment and only applied the data to women with early stage breast cancer that is hormone positive, human epidermal growth factor receptor 2/neu negative, and has not spread to the lymph nodes.
According to the analysis, the estimated individual Oncotype DX test costs were approximately $3400 and based on Medicare reimbursement rates. Another gene test called MammaPrint, which is used less often, had similar costs. Many insurers cover the cost for women diagnosed with early-stage breast cancer.
Prior to the TAILORx trial, the mean initial costs of health care for newly-diagnosed women with breast cancer included chemotherapy costs of $2.701 billion and Oncotype DX testing costs estimated to be $115 million. Cumulatively, the health care cost in the first year after diagnosis was $2.816 billion. However, the researchers indicated that only 34.8% to 57.2% of women were receiving the Oncotype DX testing during this time period.
The TAILORx findings showed that women whose tumors had lower risks for recurrence based on Oncotype DX scores did not benefit from chemotherapy. Additionally, the findings indicated that use of the Oncotype DX gene test may potentially spare 70% of women from needing chemotherapy if they are newly diagnosed with breast cancer.
Post-trial, the researchers projected that all women with scores of 0 to 25 (low to intermediate risk) would forgo chemotherapy, resulting in $338 million in savings in initial chemotherapy costs. Assuming that 100% of women would receive Oncotype DX testing, the researchers estimated that costs would increase by $116 million, leading to a total initial cost of $2.766 billion for this period.
Overall, the study showed that the combined cost of treatment and testing for the 2 initial 12-month costs of care from pre- to post-trial decreased from $2.816 billion to $2.766 billion, for a net savings of approximately $50 million.
“Personalized breast cancer treatment based on tumor genetic profiles could result in small cost decreases in the initial 12-months of care,” the researchers wrote. “Studies are needed to evaluate the long-term costs and non-monetary benefits of personalized cancer care.”
Mariotto A, Jayasekerea J, Petkov V, et al. Expected monetary impact of oncotype DX score — concordant systemic breast cancer therapy based on the TAILORx trial. JNCI: Journal of the National Cancer Institute. 2019. https://doi.org/10.1093/jnci/djz068
Genetic Testing in Women Diagnosed with Breast Cancer Decreases Cost of Care Nationwide [news release]. Georgetown Lombardi Comprehensive Cancer Center. https://lombardi.georgetown.edu/news/Genetic-Testing-in-Women-Diagnosed-with-Breast-Cancer-Decreases-Cost-of-Care-Nationwide. Accessed April 24, 2019.