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Use of genetic testing to guide breast cancer treatment could reduce costs
Personalizing treatment for patients with breast cancer based on tumor genetic profiles could reduce costs during the first year of care, according to results of a retrospective study published in Journal of the National Cancer Institute.
The estimated savings are based on the projected impact of the TAILORx trial, which was published last year in The New England Journal of Medicine and indicated use of Oncotype DX (Genomic Health) — a gene expression profile test — potentially could spare as many as 70% of women newly diagnosed with node-negative, hormone receptor-positive, HER2-negative breast cancer from costly chemotherapy.
“This study shows that changes in practice from current patterns to new standards expected based on the TAILORx trial have the potential to affect the costs of total initial cancer care for women diagnosed with node-negative, [hormone receptor]-positive, HER2-negative breast cancer,” Angela Mariotto, PhD, chief of the data analytics branch of the surveillance research program, division of cancer control and population sciences at the NCI, and colleagues wrote. “If treatment follows trial-suggested care, there is likely to be a small net cost decrease during the initial 12 months of breast cancer care, despite an increase in the cost of testing.”
The TAILORx trial demonstrated that women with this most common breast cancer subtype who had tumors with Oncotype DX recurrence scores of 11 to 25 had similar rates of distant recurrence and death related to breast cancer whether they received endocrine therapy alone or with chemotherapy. These results suggest that chemotherapy could be omitted in these patients.
Mariotto and colleagues analyzed the cost effect of providing care based on TAILORx trial evidence using data from the SEER, SEER-Medicare and SEER-Genomic Health Inc. data sets. They estimated Oncotype DX testing, chemotherapy rates, and mean initial costs among women before and after the TAILORx trial.
The analysis included 67,563 women aged 18 to 74 years with node-negative, hormone receptor-positive, HER2-negative breast cancer and tumor sizes of 1.1 cm to 5 cm or 0.5 cm to 1 cm whose care could be affected by the TAILORx results.
Researchers tested how assumptions about compliance with testing and score-suggested treatment impacted costs through sensitivity analyses.
Results showed that in the pre-TAILORx era (2010-2015), the rate of Oncotype DX testing among women with hormone receptor-positive, HER2-negative, early-stage breast cancer was 49.8% (range, 34.8-57.2). Estimated mean initial costs during this period, excluding Oncotype DX testing, ranged from $52,100 to $67,800 per woman for those who received chemotherapy and $26,600 to $34,600 per woman for those who did not receive chemotherapy.
Researchers estimated total mean initial costs including Oncotype DX testing, estimated to cost about $3,400 per test, of $2.816 billion during the pre-trial period.
In the post-TAILORx period, a projected drop in chemotherapy use from 25% to 17% would reduce initial costs by $338 million per year. Meanwhile, universal Oncotype DX testing would increase testing costs from $115 million to $231 million per year.
Overall, researchers projected total post-trial initial care costs of $2.766 billion, for a net annual savings of $49 million (range, $32 million-$102 million).
“Our results suggest that personalizing care by selecting chemotherapy based on [recurrence score] has the potential to lower short-term costs, even after considering the added costs of expanded Oncotype DX testing,” Mariotto and colleagues wrote. “Economic results are only a partial picture of the total benefits to women from changes in care based on evidence from the TAILORx trial. There are important nonmonetary benefits of the expected new treatment paradigm, including targeting of chemotherapy to those most likely to benefit, and avoiding harms among those with little to no potential benefit in terms of reduced recurrence risk.” – by John DeRosier
Additional reference:
Soprano JA, et al. New Engl J Med. 2018;doi: 10.1056/NEJMoa1804710.
Disclosures: The authors report no relevant financial disclosures.