Kristin Ciriello Pothier, MS

Breast Cancer Index (BCI) is a novel gene expression-based test 

for patients with estrogen receptor positive (ER+), lymph node 

negative (LN—) breast cancer that predicts risk of recurrence over 

10 years, and also specifically predicts risk of late (≥5 y) recurrences 

and likelihood of benefit from extended (≥5 y) endocrine 

therapy. The objective of this study was to evaluate cost utility of 

BCI from a US third-party payer perspective.

Two fact-based economic models were developed to project 

the cost and effectiveness of BCI in a hypothetical population of 

patients with ER+, LN— breast cancer compared with standard 

Costs associated with adjuvant chemotherapy, toxicity, followup, 

endocrine therapy, and recurrence were modeled over 10 

years. The models examined cost utility compared with standard 

practice when used at diagnosis and in patients disease-free at 5 

Use of BCI was projected to be cost saving in both models. In the 

newly diagnosed population, net cost savings were $3803 per 

patient tested. In the 5 years post diagnosis population, BCI was 

projected to yield a net cost savings of $1803 per patient tested. 

Sensitivity analyses demonstrated that BCI was cost saving 

across a wide range of clinically relevant input assumptions.

BCI was projected to be cost saving when used either at diagnosis 

or at 5 years post diagnosis. Cost savings are achieved through 

projected impact on adjuvant chemotherapy use, extended 

endocrine therapy use, and endocrine therapy compliance. These 

findings require validation in additional cohorts, including studies 

This health economic analysis demonstrated that use of Breast Cancer Index in patients 

with estrogen receptor positive, lymph node negative early breast cancer is cost saving 

From a third-party payer perspective, use of this test may result in substantially 

The test resulted in cost savings when used either at diagnosis or at 5 years post 

Cost savings were driven by a reduction in adjuvant chemotherapy in patients unlikely 

to derive benefit (when used at diagnosis), and optimization of extended endocrine 

therapy utilization in patients likely to receive substantial benefit (when used at 

Each year more than 230,000 women are diagnosed 

subset of patients with estrogen receptor positive 

(ER+), lymph node negative (LN—) breast cancer has 

a better overall prognosis than patients in other clinical 

subsets (eg, triple negative breast cancer, human epidermal 

growth factor receptor 2—positive [HER2+] breast cancer). 

However, one of the hallmarks of ER+ breast cancer is the 

persistent risk of recurrence that extends greater than 15 

years after initial diagnosis and treatment.

surgical intervention and 5 years of endocrine-based therapy, 

patients and physicians have 2 important therapeutic 

considerations: first, whether or not to receive adjuvant 

chemotherapy; and second, whether to extend endocrinebased 

therapy beyond 5 years. These difficult clinical decisions, 

which are multifactorial and must balance the 

potential risks and benefits of therapy, have led to the development 

of multiple prognostic and predictive tools to 

Significant focus has been placed on supporting the adjuvant 

chemotherapy decision. Over the past decade, a number 

of molecular assays designed to predict risk of recurrence 

and chemotherapy benefit for ER+ patients have become 

commercially available. These molecular assays have been 

incorporated into clinical practice, have been shown to impact 

clinical decision making regarding the use of adjuvant 

 and have been incorporated into clinical 

 Finally, gene expression—based assays have 

Articles

This study projected that the breast cancer index assay is cost saving when used either at diagnosis or at 5 years post diagnosis.

Kristin Ciriello Pothier, MS

Articles

Health Economic Analysis of Breast Cancer Index in Patients With ER+, LN- Breast Cancer