Cost-utility analysis of 21-gene assay for node-positive early breast cancer.

Masucci L1, Torres S2, Eisen A2,3, Trudeau M2,3, Tyono I2, Saunders H1, Chan KW2,3,4, Isaranuwatchai W1,4,5.

Author information

1: Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, University of Toronto, Toronto, ON.
2: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.
3: Cancer Care Ontario, University of Toronto, Toronto, ON.
4: Canadian Centre for Applied Research in Cancer Control, University of Toronto, Toronto, ON.
5: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.

Abstract

BACKGROUND:

For women with lymph node (ln)-positive, estrogen receptor-positive, and her2 (human epidermal growth factor receptor 2)-negative breast cancer (bca), current guidelines recommend treatment with both hormonal therapy and chemotherapy. The 21-gene Recurrence Score (rs) assay might be helpful in selecting patients with bca who can be spared chemotherapy when they have 1-3 positive lns and a lower risk of recurrence. In the present study, we performed a cost-utility analysis comparing use of the 21-gene rs assay with current practice from the perspective of a Canadian health care payer.

METHODS:

A Markov model was developed to determine costs and quality-adjusted life-years (qalys) over a patient's lifetime. Patient outcomes in both study groups were examined based on published clinical trials. Costs were derived primarily from published Canadian sources. Costs and outcomes were discounted at 1.5% annually, and costs are reported in 2016 Canadian dollars. A probabilistic analysis was used, and the model parameters were varied in a sensitivity analysis.

RESULTS:

The results indicate that use of the 21-gene rs assay was less costly ($432 less) and more effective (0.22 qalys) than current practice. The probabilistic analysis revealed that 70% of the 10,000 simulated incremental cost-effectiveness ratios were in the southeast quadrant. The results were sensitive to the probability of a low rs and to the probability of receiving chemotherapy in the low-risk rs category and in current practice.

CONCLUSIONS:

Use of the 21-gene rs assay could be a cost-effective strategy for Ontario patients with estrogen receptor-positive, her2-negative early bca and 1-3 positive lns.

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